m 



I 



mm 



41 



5 



■ 



Hi 

Hi 

HI ■ 















V* 





















++ V* 






























^^ 






^ ,^ 














































































.,,• 









/ 

AN 




^ ON 

MORBID SENSIBILITY 

OF THE 

STOMACH AND ^OWEIiS, 

AS THE PROXIMATE CAUSE, OR CHARACTERISTIC CONDITION 
OP 

NERVOUS IRRITABILITY, IVIENTAL DESPONDENCY, 
HYPOCHONDRIASIS, &c. &c. 



TO WHICH ARE PREFIXED, 
OBSERVATIONS ON THE DISEASES AND REGIMEN OF INVAL- 
IDS, ON THEIR RETURN FROM HOT AND UNHEALTHY 
CLIMATES. 



BY JAMES JOHNSON, M. D. 

OF THE ROYAL COLLEGE OF PHYSICIANS, &C. 












, 



PUBLISHED BY BENJAMIN & THOMAS KITE, 

SOLD BY THEM, J. GRIGGS, & J. G. AUNER, 
AKD BY S. WOOD & SONS NEW-YORK. 



1827. 






* *» \ 



K 






PREFACE. 



The following Essay is re-printed from 
the Fourth Edition (just published) of my 
Work on the " Influence of Tropical* 
Climates on European Constitu- 
tions," for the convenience of those who 
may be in possession of former Editions, 
or who may not be inclined to possess the 
present one. 

The subject of this Essay has occupied 
the pens of so many able writers, of late, 
that some excuse may seem necessary for 
another tax on the Public. The present, 
however, is not a very heavy tax on the 
purse or patience of the reader ; for if it he 
a bad, it is, at all events, not a large book. 
I shall not therefore offer an apology, 
since no apology will procure a favourable 
reception for him who obtrudes himself 
unnecessarily on the time and attention of 
his professional brethren. 

The materials of this Essay have been 
drawn entirely from personal observation, 
and not a few of them from personal suf- 
fering ; and if I have questioned certain 
popular doctrines, and insisted on a more 
rigorous system of self-control than may 
A 



IV PREFACE. 

suit the ideas of many people, both in and 
out of the Profession, I have done so on the 
sure ground of experience. Those who 
disrelish the precepts I have laid down — 
•or who may think the promised advantages 
too dearly purchased by the proposed sac- 
rifices, have only to go on, till time and 
ill health induce them to think more seri- 
ously on the work of reformation. I have 
not preached Utopian doctrines on the 
subject of diet — I have proposed nothing 
but what has been practised by many 
others as well as by myself with advan- 
tage — and I am confident that he who 
fives the plan a fair trial, will never con- 
emn it, even if he have not fortitude to 
pursue it. 

In this Essay I have endeavoured to in- 
vestigate the operation of moral causes on 
the digestive organs, more minutely than 
has generally been done ; and to trace, 
with more care, the reaction of these or- 
gans on the mental faculties. The amount 
of suffering which is inflicted on the body 
through the agency of the mind, is only 
equalled by the retributive misery reflec- 
ted on the mind through the medium of 
the body. The play of affinities and re- 
ciprocity of sympathies between the intel- 
lectual and material portions of our nature, 
have not been sufficiently attended to in 
the investigation and management of dis- 



PREFACE. 



eases ; and I am not without hope that 
this Essay may be instrumental in lessen- 
ing the extent of human maladies by in- 
creasing our knowledge of their moral as 
well as physical causes. 

In the treatment, I have ventured to ex- 
pose the injury which is done to the stom- 
ach by a farrago of tonics and stimulants, 
as well as by violent purgation — while I 
have shewn the efficacy of some simple 
remedies when judiciously employed. — 
But, above all, I nave endeavoured to de- 
monstrate the true principles on which the 
plan of diet and regimen should be con- 
structed, not only in indigestion, but in a 
host of mental and corporeal discomforts 
which are little suspected of having their 
origin in the stomach. Having long suf- 
fered from this class of complaints, in my 
own person, my attention has been strong- 
ly drawn to it in others. The result of 
my experience is here given, in as small a 
space as possible, and the Public will de- 
cide whether or not my observations have 
been correct, and the deductions from them 
legitimate. 

JAMES JOHNSON. 

Suffolk Place, Pall Mall East, 
1st Nov. 1S26, 



vi CONTENTS 

PART I. 

DISEASES AND REGIMEN OF INVALIDS FROM HOT CLIMATES. 

Page 
The Youth setting out, and the Invalid returning home, con- 
trasted -------..8 

Dangers on returning to a Cold from a Hot Climate - - 10 

The lungs liable to take on Disease - - . - - 11 

Conduct on the Voyage Home from India - - - 19 

Necessity of strict Abstemiousness on Embarking for Europe 13 

The Danger of Hypochondriasis after returning 14 

Debility on the Voyage Home ------ 15 

Great Danger from too much Food - - - - - 16 

Rules for Food and Medicine 17 

Bowel Complaints on the Passage Home 22 

Dietetic and Medicinal Treatment of - - 23 

Sympathetic Affection of the Chest, on the Voyage Home - 32 
Observations on Dyspeptic Consumption, as it is improperly 

called ----------33 

Stages — Diagnosis by Auscultation — Treatment - - 35 

Organic Disease of the Liver 39 
Deceptive Methods of ascertaining Organic Disease of this 

Viseus ---_._-_-40 

Diagnosis of Disease in the Liver ----- 42 

Different Kinds of Organic Disease of the Liver 43 

Wasting of the Flesh a characteristic Symptom - 45 

Treatment of Organic Disease of the Liver 47 

PARTE. 

on morbid Sensibility of the stomach and bowels, &c. &c. 

Prevalence of this Disease among all Classes of Society - 52 

Various Designations by which it is known 53 
Indigestion, Dyspepsia, Hypochondriasis, Bilious Disorder, 

all only forms or features of the disease 54 
Distinction between the Ganglionic and Cerebro-spinal 

Nerves - - -- - - - - ib. 

Different Kinds of Sensibility in different Nerves ib. 
Illustrations of this Difference of kind, in the Sensibility of 

Nerves ---------55 

Organic and common Sensibilities of the Stomach ib. 
Danger of exciting common Feeling or Sensibility in the 

Stomach --------57 

Food and Drink ought to produce no Sensation in the 

Stomach - - - - - - ib. 

excite Sensations of Comfort during Health in dis- 
tant Parts of the Body - - - - - - ib. 

Irritation of the Stomach produces unpleasant Sensations in 

distant Parts of the Body, with or without Pain in the 

Stomach itself -- ------ 5S 

Two Classes of Sympathetic Effects from Irritation in the 

Stomach 59 

Class I, — Morbid Sensibility of the Stomach and Bowels, with 

obvious Disorder of those Organs - - - - 63 



CONTENTS. Vii 

Page 

Symptoms of a Fit of Intemperance ----- 64 
The Manner in whicn Morbid Sensibility is formed, and the 

Foundation of Indigestion established 66 

Strictures on Dr. Philip's Stages of Indigestion - - ib. 
•* Indigestion " a Conventional Term — the Author's Rea- 
sons for using the Term tw Morbid Sensibility " of the 

Gastric and Intestinal Nerves ----- 67 

Symptoms of Liver and Stomach Affection combined - 68 
Distressing Effects of vitiated Bile on the Digestive Organs, 

and through them, on the Mental Functions - - 69 
Effects of Biliary Irritation on the Tongue, Eyes, Kidneys, 

and other Parts of the Body - ' - - - - 71 
Distressing Sense of Debility, varying with the State of the 

Stomach 73 

Tenderness of the Pit of the Stomach, a deceptive Symptom 74 
Strictures on Dr. Philip ? s Remarks on this Subject, and on 

the Organic Diseases to which Indigestion is said to lead ib. 

Pain in the Region of the Stomach, Remarks on - - 78 

Hardness of the Pulse, Remarks on - - - - - 79 

Febrile Symptoms, Remarks on- - - - - -82 

Changes produced in the Mucous Membrane of the Stom- 
ach by a long Continuance of Irritation there - - ib. 
Sympathetic Affections of various Parts of the Body from 

Irritation of the Digestive Organs 83 

Sympathetic Affections of the Brain - - - - 85 

of the Nerves of Sense, as of Sight and Hearing ib. 

of the Heart - - - - - - -86 

of the Lungs ------- 87 

of various other Parts of the Body - - - 88 

Class 11. — On Morbid Sensibility of the Stomach and Boiveb, . 

without any obvious Disorder in those Organs themselves 89 

Physical Causes of this Morbid Sensibility - - - ib. 

' bad Air — want of Exercise — late Hours - - 90 

Diet, the chief Physical Cause - - - 91 

Criteria of the injurious Effects of Diet 99 

Drink, a powerful Physical Cause - - - 93 

Moral Causes of Morbid Sensibility, as Anxiety of Mind 

■ &c. &c. - - 94 

— Modes in which they act on the Stomach - - 96 

Effects on Moral Causes exasperated by Food and 

Drink --------- tb, 

Hypochondriasis, Remarks on the Doctrines which have 

been broached respecting this distressing Malady - 97 

Doctrines of Cullen, Broussais, Falret, and of the 

Ancients ---------98 

Hypochondriasis, Doctrine of Villermay, appears the near- 
est to truth — namely, Change in the Organic Sensibili- 
ties of the Visceral Nerves ------ 99 

Graphic Sketch of this Disease - - - - 100 

People most liable to it - - - - - - 103 

Symptoms of its early approach - - - - 104 

Exasperated and mitigated by Diet " - - - 105 



Vlll CONTENTS. 

TREATMENT OF MORBID SENSIBILITY OF THE STOMACH AND BOWELS, 
DIETETIC AND MEDICINAL. 

DIETETIC TREATMENT. Page 

Simplification of the Indications to be pursued - - - 107 

Chief Indication, the Removal of the Sources of Irritation - 108 

Regulation of Diet, the first object - - - - - ib. 
Danger of prescribing Medicines in this Disease, without first 

establishing a System of unirritating Diet ib. 
Rules for establishing a Regimen adapted to the Degree of 

Morbid Sensibility, or to the Digestive Power of the 

Stomach 109 

Criteria respecting the Quantity and Quality of Food that 

may be taken without injury - - - - -110 

Observations on Drink - - - - - - -114 

Necessity of Firmness and Resolution in pursuing proper 

Regimen --------- \\Q 

MEDICINAL TREATMENT. 

State of the Secretions to be first ascertained - - - 116 

Hints for ascertaining the State of the Secretions - - 117 

Danger of irritating Purgatives in Dyspeptic Complaints - 118 

Various FormulfE for Aperients ------ 119 

Cases where Mercury may be necessary, or not - - - lril 

Observations on White Mustard Seed - 122 
Means for reducing the Morbid Sensibility of the Gastric 

Nerves --------- ib. 

Counter-irritation externally ------ if,. 

Anodynes, with Blue Pill and Ipecacuan - 123 

Hyosciamus with Blue Pill, a valuable Sedative - - - ib. 

Vegetable Bitters and Tonics - - - - - - 124 

Danger of their too early Administration - %b. 

Nitrate of Silver, an important Sedative in Morbid 

Sensibility of the Gastric and Intestiual Nerves - 125 

-Cases in Illustration of its Utility ib. 

Sulphate of Quinine, the best, and almost the only Bitter 

Tonic that is necessary - . - - - - - log 

Rules for administering this remedy in Dyspepsia - - 129 
Treatment of Sympathetic Affections of various Parts of the 

Body 130 

MORAL AND PHYSICAL REMEDIES COMBINED. 
Rules for the Management of Exercise - - - - 134 
MORAL AND PHYSICAL EFFECTS OF TRAVELLING. 
Plan of a three months' Tour for the Restoration of Health 137 
Amount of Active Exercise taken by the Author on a Tour 139 
Routine of Exercise, Diet and Rest - - - - 140 
Investigation of the Moral Effects of Travelling - - 1 42 
Investigation of the Physical Effects of Travelling - - 145 
Effects on the Sensibility of the Body to external 

impressions of the Atmosphere - - - - 146 

Effects of the Lungs of Phthisical People - - 148 

Effects on the Organs of Digestion - 149 

Effects on the Absorbent System and Secretions 150 

Effects on Dropsical Dispositions - _ - ib. 

Effects on the Heart and Circulating System - L*2 

Effects on the Blood itself - - - - 153 



PART I. 
OHST&RVATI0X& 

ON THE 

DISE&SES HMD HBGIMEH 

OF 



ON THEIR RETURN FROM 

HOT AND UNHEALTHY CLIMATES. 



The English youth leaves his native shores, with 
vigorous health and buoyant spirits, for a foreign 
land of promise, where he is to meet with adven- 
tures, acquire fame, and realize a fortune. All the 
happy events, real or ideal, of his future journey 
through life, are painted by his ardent imagination, 
in prominent characters, on the foreground of the 
scene; while reverses, sickness, disappointments — 
death itself, are all thrown into the shade, or, if 
suffered to intrude, only serve as incentives to the 
pursuit which has been commenced. 

During the short span of existence to which man 
is doomed on earth, it is a merciful dispensation that 
youth anticipates no misfortune; and that, when 
the evil day arrives in after life, Hope comes, on 
glittering wing, and gilds the scene even till the 
last ray of our setting sun is extinguished ! 
B 



9 ON THE DISEASES AND REGIMEN 

I have already pourtrayed, in another place, the 
dangers which the tropical sojourner runs, the dis- 
eases to which he is subject, the remedies which 
experience has found most effectual, and the regi- 
men which appears to me most appropriate in the 
Torrid Zone. A task remains, which I have not 
hitherto undertaken ; but which the experience and 
observation of twenty years may now enable me to 
accomplish. The nature of that task is explained 
in the title of this part of my work. 

An epoch, sooner or later, arrives (and most wel- 
come it generally is) when the completion of a pe- 
riod of service; the acquisition of competent for- 
tune ; or, what is more frequent than any other, 
the loss of health, points to a return to our native 
land — a land which the more constantly engrosses 
our daily thoughts and nightly dreams, the farther 
we are distant and the longer we are absent from 
it ! None but those who have sojourned for years 
on foreign shores, can appreciate the feelings of the 
European, who wastes the prime of life beneath a 
tropical sun, languishing in body, and pining in 
thought to revisit the scenes of his youth, 

While every form that Fancy can repair 
From dull Oblivion glows divinely there I 

If he crossed the seas, in early life, full of antici- 
pations, that can, alas ! be but rarely realised ; he 
shapes his course back again across the same path- 
less deep, with chastened but scarcely less ardent 
hopes of health and happiness on the soil which 
gave him birth. — Here, too, he is destined to en- 
counter dangers as well as disappointments. The 
powers of the constitution, however plastic, cannot 
immediately accommodate themselves to great and 
len changes of climate, even when the transition 

Froifi a bad to a good one: and the tropical inva- 



OF INVALIDS FROM HOT CLIMATES. 1C 

lid requires full as much caution and prudence in 
approaching the shores of England, as he did in 
landing at a former period, on the banks of the 
Ganges. 

When the European has become much debilitat- 
ed by liver affection, dysentery, or fever and its 
consequences, his main hope of recovery rests on 
change of climate, and under such circumstances, 
the sea voyage will often effect the cure. Indeed 
the instances are not few where more benefit is oh-- 
tained by the voyage home, than by subsequent 
residence in England. The voyage, though not 
totally free from inconvenience, presents not the 
thousand temptations to deviate from regular habits 
and regimen, which afterwards assail the tropical 
invalid, when he mingles with society in his native 
country. Besides, the uniformity and salubrity of 
the sea-air, aided by the mental exhilaration of a 
homeward voyage, produce surprising effects on 
the animal economy. During this voyage the ef- 
fects or sequelae of fevers generally disappear, and 
both appetite and strength return. But chronic 
dysentery and hepatitis are not so easily removed, 
and these the tropical invalid most commonly brings 
with him to Europe — sometimes considerably miti- 
gated, but at others, rather exasperated, especially 
if stormy wet weather is experienced off the Cape, 
or if the ship arrives in the channel at an unfavour- 
able period of the year. By residence in a hot cli- 
mate, the constitution becomes assimilated to it, 
and, in some measure changed. The return, there- 
fore, to a cold, though more healthy latitude, is 
liable to produce, if great care be not taken, a de- 
termination to those organs which have been wea- 
kened by previous disease; and thus a more or less 
acute inflammation is often set up in the mucous 
membrane of the bowels ; or they are rendered 
more irritable than before the invalid left India. A 



11 OP THE DISEASES AND REGIMEN 

subacute inflammation of the liver is sometimes thus 
superinduced on a chronic disease or torpid state of 
that organ, requiring not only the subduction of the 
stimulus of food and drink, but even local abstrac- 
tions of blood from the region of the liver. 

But the most serious consequence of a return to 
Europe, after long residence in a tropical climate, 
is the aggravation or even production of disease in 
the chest. The mucous membrane of the lungs 
sympathises readily with that of the stomach, and 
thus produces what is called a stomach cough. 
Chronic diseaseof theliver produces the same thing, 
whether by means of sympathy, or simply by con- 
tiguity with the diaphragm, which is so intimately 
connected with the organ of respiration. Now, in 
a great majority of instances, these affections of the 
chest are only symptomatic, even when the inva- 
lid has returned to Europe, and will subside in pro- 
portion as the functions of the stomach and of the 
liver are restored. But, on the other hand, there 
are many cases where the symptomatic affection of 
the chest has continued so long as to induce actual 
disease there ; which disease will not be removed, 
nor even materially relieved by the remedies pre- 
scribed for the liver or stomach complaint. 

In this country, the symptomatic aflection of the 
lungs in chronic hepatitis and indigestion, has ex- 
cited much attention, and has been treated of under 
the names of ' f hepatic phthisis, " dyspeptic phthis- 
is," and " stomach cough." Where there is evi- 
dently derangement of the liver or stomach, and 
the patient is lately from a hot climate, the English 
practitioner sets down any pulmonary affection that 
may be complained of, as symptomatic, of course, 
of the abdominal disorder ; and thus, that time is 
lost in abortive attempts to remove both classes of 
complaints by striking at the original one, which 
might have saved the lungs from irremediable dis- 



OP INVALIDS FROM HOT CLIMATES. 12 

organization. Many are the instances I have seen, 
and continue to see, where patients have been pro- 
nounced to be labouring under symptomatic disease 
only, while a few minutes' examination of the chest 
by percussion and auscultation detected organic chan 
ges in the lungs or heart which had passed the pe- 
riod when any chance of recovery could be expect- 
ed. This, in fact, is one of the greatest dangers 
which the tropical invalid runs, when he embarks 
for his native climate, where pulmonary complaints 
are the prevailing diseases. On this account, he 
should, from the moment he goes on ship-board, 
pay the utmost attention to his dress, and most cau- 
tiously avoid all exposure to wet and cold on the 
voyage homewards. This caution is not le*ss neces- 
sary for the invalid affected with the usual conse- 
quences of tropical diseases only, and where the 
chest is free at the time he embarks. As he ap- 
proaches the Cape, and afterwards the Channel, he 
is much more liable to pulmonary affection than a 
person who has never suffered from hepatic or stom- 
ach disorder; and, if the chest once becomes affect- 
ed, he is much more exposed to fixed and danger- 
ous disease there. If the pulmonary affection, even 
of the mildest kind, and purely symptomatic, has 
manifested itself between the tropics, he is in still 
more danger; and if the English practitioner faiis 
to make the most rigid examination of the chest, 
on his arrival, he becomes morally responsible iox 
all the serious consequences which may subsequent- 
ly result from this neglect. In short, I have no hesi- 
tation in asserting, that the disorder of the chest, 
even if purely symptomatic, demands more atten- 
tion, and is really of more importance than the ab- 
dominal disorder from which it arose. There is lit- 
tle or no organic disease of the liver in one case out 
of the twenty of those who return to this country 
labouring under " liver complaint" — and this re~ 
B 2 



13 ON THE DISEASES AND REGIMEN 

mark is still more applicable to the stomach — con- 
sequently j there is but little risk of life. But if the 
lungs once become affected in structure; if symp- 
tomatic be confounded with organic derangement, 
or suffered by neglect to pass into that state, the 
case will rarely be otherwise than fatal. 

The surgeon of the ship, therefore, should take 
an early opportunity of examining the chests of all 
invalids complaining of cough, or who are easily 
put out of breath on ascending ladders, &c. If they 
cannot lie low in bed, or take in a deep inspiration 
without exciting cough ; and still more, if they feel 
uneasiness in any part of the chest, the case should 
be immediately attended to before the patient gets 
into the high latitudes, where the malady will cer- 
tainly be increased. A blister, a few leeches, 
or a crop of pustules excited by tartar-emetic, aided 
by warm dress, abstinence from stimulating drink, 
and some gentle diaphoretic to act on the skin, 
would save many a day's sufferings afterwards — 
nay, many a valuable life. But of this more here- 
after. 

It is on the voyage to England, where there are 
many circumstances favourable to the object in view, 
that the invalid should seriously think of adopting 
a system of diet and regimen that might not only 
obviate any injurious effects of a sudden transition 
from a hot to a cold climate, but contribute mate- 
rially to the removal of those complaints contracted 
by residence in the former. It cannot, indeed, be 
too strongly impressed on the mind of the tropical 
invalid, that without a firm resolution to coerce his 
appetites into complete subjection, and make them 
subservient to the restoration of his health, he will 
gain little by a return to his native skies ; but, on 
the contrary, he will either confirm those maladies 
under which he already labours, or, what perhaps 
is worse, convert them into forms less formidable 



OP INVALIDS FROM HOT CLIMATES. 14 

indeed in appearance, but effectually subversive of 
every enjoyment, mental or coporeal, which can 
render life desirable. Of all the miseries to which 
man is liable, by the frailties of his nature, there is 
none more terrible to endure, or difficult to remove, 
than that hypochondricaal despondency which is 
sure to settle on the tropical invalid, in his own 
country, in the midst of his friends, and in the pos- 
session of wealth, unless he succeeds, by timely and 
proper measures, in correcting those morbid condi- 
tions of the digestive organs, from which this dae- 
mon draws a gigantic power and influence, that ty- 
ranize over all fortitude, philosophy, and even re- 
ligion itself! The extent of this evil is so great in 
these isles, that it has been suspected, and not with- 
out probability, that our tropical colonization has 
introduced and propagated, by hereditary descent, 
a strong disposition to stomach and liver affections 
beyond that which is observed in any other coun- 
try. Be this as it may, the instances of insanity 
and suicide, from this cause, are not exceedingly 
rare; while the number of hypochondriacs, cursed, 
I might almost say, in the possession of reason, but 
driven to despair by the torture of their own mor- 
bid feelings and nervous irritation, which may be 
seen in all parts of the British dominions, but espe- 
cially at watering places, is truly astonishing! Of 
these, our tropical invalids form no inconsiderable 
portion ; and although the wretchedness of their 
sensation is only known to themselves, their medi- 
cal attendants, and some of their intimate acquaint- 
ances, the amount of it is great beyond all calculation. 
That this unhappy winding up of a life spent un- 
der a burning sun, in the acquisition of wealth, and 
in the vain expectation of enjoyment in declining 
years, cannot always be prevented, is but too true; 
yet, at the same time, I know from repeated exam- 
ples and multiplied observation, that a rigid system 



15 ON THE DISEASES AND REGIMEN 

of self-control adopted as soon as the individual 
withdraws himself from under the deleterious in- 
fluence of a hot climate, and persisted in for a cer- 
tain time after his arrival in Europe, would, in nine 
cases out of ten, be fallowed, not only by restora- 
tion of health, but by an equilibrium of spirits and 
mental serenity which none but the temperate, the 
abstemious, and the prudent, can possibly appreci- 
ate. This system will be detailed farther on. 

The principal states of indisposition under which 
an invalid embarks for Europe, are debility from 
long-continued disease of the liver, or the remedies 
unavoidably employed for that complaint ; debility 
from fever, or a continuance of regular or irregular 
paroxysms of the disease ; and bowel-complaints. 

Debility can only be removed, of course, by the 
introduction of nutriment into the system; but this 
does not always follow the introduction of food into 
the stomach, even when taken with considerable 
relish. One of the first effects of the sea-air is an 
increase of appetite, and the invalid hails this as a 
favourable omen, and indulges the propensity to 
eat. The debility of the various organs, however, 
and their previous desuetude to much nourishment, 
seldom permit this new propensity to be satisfied, 
without subsequent detriment. Indigestion, fever- 
ishness, or irritation of the bowels is almost sure to 
follow too free an indulgence of the appetite, and 
consequently there is no increase of strength from 
this temporary return of desire for food. Jlppetite, 
indeed, is a bad criterion for taking food; digestion 
- — easy digestion, is the only sure guide. If we 
feel uneasy after four ounces of food, but comforta- 
ble after the ingestion of two ounces, we shall de- 
rive more support from the latter than from the 
former. The quantity and the quality of the food 
must be both carefully regulated ; and, in general, 
the invalid's own feelings will warn him when he 



OF INVALIDS FROM HOT CLIMATES. Id 

has erred on either point. But this is not always 
the case. There is no effect of indigestion more 
common than dejection of mind, when no corpo- 
real inconvenience appears to follow. The nerves 
of the stomach and upper bowels will be irritated, 
and this irritation will be propagated to the whole 
nervous system, and all its moral and intellectual at- 
tributes, by quantities and qualities of food which 
excite no sensible uneasiness in the organs of diges- 
tion, and produce no change in the secretions or ex- 
cretions by which the evil might be detected. A 
want of attention to this circumstance — or rather a 
want of knowledge of it, has led, and leads daily, in 
numerous instances, to states of mental desponden- 
cy, ending ultimately in complete hypochondria- 
cism. In insanity, the morbid condition of the 
mind is invariably dependent on a morbid condi- 
tion of the body, (whether indu#ed by moral or 
physical causes,) although the latter is rarely cog- 
nizable by external corporeal symptoms. This 
holds equally good in hypochondriacism. The 
mental despondency is invariably dependent on 
some disorder of the body, and, in nine cases out of 
ten, it is immediately dependent on a morbid or ir- 
ritable slate of the nerves of the stomach and bow- 
els. Of the truth of this I have had such multiplied 
proofs, that not a doubt remains on my own mind 
respecting it. It is as useless to attempt the remo- 
val of this mental despondency by moral means or 
mere persuasion, as to try to remove a fever or an 
inflamation by argument. The attempt, indeed, be- 
trays a great ignorance of the real nature of the com- 
plaint in the physician. Moral means may certain- 
ly contribute to improvement of the general health, 
and this will much improve the state of the diges- 
tive organs, on which the mental despondency de- 
pends. It is only in this way that moral means can 



17 ON THE DISEASES AND REGIMEN 

have any influence on hypochondriacism. But of 
this, more hereafter.* 

If the invalid only labours under that debility pro- 
duced by fever and the remedies used for it, the 
sea-air and the gradual increase of tone in the di- 
gestive organs will generally be sufficient to renew 
the strength, under the caution above-mentioned 
respecting diet. In such cases it can rarely be pru- 
dent to exhibit direct tonics at the beginning of the 
voyage. A warm bitter is quite sufficient, as equal 
parts of infusion of ginger and gentian, with four or 
five grains of carbonate of soda, and a drachm or two 
of any bitter tincture in each dose. The bowels 
should be regulated by mild aperients that do not 
produce thin or watery discharges — an operation 
which should be avoided, but which, I am sorry to 
say, continues to do infinite mischief. Many prac- 
titioners and patJlnts are absolutely infatuated with 
the benefit to be derived from the blue pill at night, 
and the black dose in the morning. This medicine 
certainly sweeps away abundance of thin, fetid, and 
unhealthy secretions, and the patient feels lighter 
and more comfortable for a time; but a repetition 
of the practice produces the very secretions which 
it is designed to carry off or prevent. After clear- 
ing the bowels in this way, the great object is to 
procure formed motions, if possible, and that not 
oftener than once in the 24 hours. That medicine 
which goes slowly and without irritation along the 
intestinal canal, permitting the nutriment to be ta- 
ken up by the absorbents, and gently stimulating 
the large intestines to discharge the useless residue, 
is the one to which we should have recourse. Aloes 
is the basis of such medicine; but as, in the class of 
patients now under consideration, there is generally 

* The functional and organic diseases of the liver will be treated 
of presently, in conjunction with dyspepsia, from which they are 
rarely free, in tropical invalids. 



OP INVALIDS FROM HOT CLIMATES. 18 

a defective or vitiated condition of the billiary se- 
cretion, and an irritable state of the gastric and in- 
testinal nerves, together with a torpid skin, it is 
necessary to combine other medicines with the 
aloes. A grain of blue pill, three or four grains of 
extract of hyosciamus, and a quarter of a grain of 
ipecacuan, combined with as much aloes as is suffi- 
cient to move the bowels once daily, will be found 
a valuable form of aperient for the invalid on the 
voyage home. The hyosciamus allays the morbid 
irritability of the nerves of the digestive tube; the 
blue pill gently excites the hepatic secretion as well 
as the pancreatic .and gastric ; the ipecacuan acts 
mildly on the skin ; while the aloes carries the 
whole slowly along the canal, and finally expels the 
faecal remains in the course of the ensuing day. 
Some little time may be necessary to ascertain the 
proportions of these medicines that may suit indi- 
vidual cases; but there can be little difficulty in ob- 
taining the proper result in the end. It is supposed 
that a disposition to haemorrhoids is an insuperable 
objection to aloes, or the compound extract of colo- 
cynth. This has been proved to be an error, and 
aloes is now commonly given by some of the best 
London practitioners for haemorrhoids. It is too 
much purging that increases and irritates piles 
rather than the kind of purgative. Where it is 
desirable to procure one free and copious operation 
in the morning, a common seidlitz powder taken at 
7 o'clock, and before breakfast, will pretty certain- 
ly have this effect. 

If the tropical invalid continues to be teased with 
regular or irregular paroxysms of fever, in spite of 
the above means, the sea-air, and strict regimen; 
then we must have recourse to certain specifics, 
and above all to the sulphate of quinine, a medicine 
which is indeed of singular efficacy, when properly 
managed, in many of those morbid conditions of 



19 ON THE DISEASES AND REGIMEN 

the digestive organs, resulting from the influence of 
tropical climates. The doses, however, should be 
small in the cases now under consideration, where 
there is generally some obstruction or congestion 
in the liver or spleen. The surgeon should atten- 
tively examine the state of these viscera, and by lo- 
cal detractions of blood and counter-irritation, re- 
move or lessen those affections on which the re- 
turns of the febrile paroxysm depend. When these 
organs are secured by such means, then from one 
to three grains of the quinine should be given every 
six hours, during the intermissions, in an infusion 
of bark, quassia, or gentian: and neither the sur- 
geon nor patient should be over anxious to stop at 
once these paroxysms by larger doses of the medi- 
cine. It is far better gradually to give tone to the 
whole digestive apparatus, while the secretions of 
the glandular viscera are slowly improved by the 
mild aperient above-mentioned. The attacks, at 
first mitigated and ultimately stopped, in this slow 
manner, will be far less liable to recur, than when 
overwhelmed suddenly by such powerful tonics as 
the quinine and arsenic in large doses. The inval- 
id, however, ought to continue the use of quinine, 
in conjunction with bitters and aperients, for a con- 
siderable time after all periodical accessions have 
ceased, since changes of weather, irregularities in 
diet, and many other causes are very apt to repro- 
duce the paroxysms. 

Although the subject of diet will be particularly 
considered farther on, yet it may not be improper 
to glance at it in this place. A ship cannot be sup- 
posed the best place for adopting a systematic course 
of diet, but as, from the pharmacopoeia, we select a 
very small number of medicines for practical use, 
so from the interminable list of culinary substances, 
a very few, indeed, will suffice for the necessary 
nutriment of man, especially when he is in a vale- 



OP INVALIDS PROM HOT CLIMATES. 20 

tudinary state. In health, we may pamper the sen- 
ses ; as invalids, we must consult the organic sen- 
sibility of the stomach and bowels, without any re- 
ference to the palate. If we do not, we pay the 
penalty most severely. 

The tropical invalid then, returning for debility, 
resulting from liver complaint, long courses of mer- 
cury, or protracted fevers of whatever type, should 
breakfast on ship-biscuit or stale bread, without 
butter, and black tea, or coffee, with very little milk 
and sugar. A slice of cold meat is better than but- 
ter for breakfast. As dinner is at an early hour, he 
should rarely give the stomach any more to do till 
that period. He should then dine on from one to 
six ounces of plain animal food, according to his 
digestive powers, without vegetables of any descrip- 
tion, unless stale bread or ship-biscuit be classed un- 
der that head. This will seem a most terrible rule ! 
It is so in appearance, after the luxuries and provo- 
catives of an oriental table. But let the invalid pur- 
sue it only till he passes the Cape of Good Hope, 
and then he has permission to change it, and adopt 
what system he pleases. If he will not adopt so 
rigid an abstinence from vegetable matter at dinner, 
the best thing next to biscuit or stale bread is well 
boiled rice, rice or bread-pudding, or a dry, mealy 
yam. In England a mealy potatoe may be tried, 
but even this is apt to irritate the disordered nerves 
of a dyspeptic invalid. 

In respect to drink, a table-spoonful of good bran- 
dy to two wine-glassfuls of water, is a mixture pre- 
ferable to wine of every kind. If a sense of thirst 
prevail while masticating well and slowly his food, 
he must take some of this drink : if not, let him fin- 
ish before he drinks. The above potation should 
be made to suffice if possible ; and double the quan- 
tity should hardly ever be exceeded. It will be 
said that constitutions differ, and what will agree 
C 



21 ON THE DISEASES AND REGIMEN 

with one stomach will not agree with another. This 
may be true; but we cannot make rules for excep- 
tions. There will not be one individual in fifty 
with whom the above plan will be found to disa- 
gree. We know, indeed, that some people will 
rather indulge the senses than improve the health, 
and these will aver that such a rigid system of diet 
entirely disagrees with them. They have truth 
laid before them here ; they may adopt it or neglect 
it as they think proper. The penalty will fall on 
themselves, not on the prescriber. It is hardly ne- 
cessary to say, that no other dessert than biscuit is 
at all to be thought of. 

Tea or coffee, with biscuit, at 6 o'clock, and half 
a pint of good gruel, sago, or arrow root, with a 
table-spoonful of brandy, for supper, should close 
the day, at ten o'clock in the evening. The inva- 
lid should then go to bed ; and if he has been ac- 
customed to more stimulation than the above scale 
affords, he will pass some sleepless nights, and be 
often tempted to break the vile system of abstemi- 
ousness which the doctor has prescribed. Let him 
persevere. Sleep will come — and that, too, of a 
more refreshing quality than ever followed the stu- 
pefying influence of wine or spirits. We da : ly 
hear it remarked, that long established habits of in- 
temperance cannot be safely interrupted at once. Of 
the truth of this I have much doubt, because I have 
seen a few — alas ! a very few instances, where 
downrighthabitual intoxication was suddenly check- 
ed, without any bad consequence resulting. But 
this is not the point under consideration. I am 
speaking of habits which are looked upon as far 
within the limits of temperance; for instance, the 
habit of drinking a pint of wine after dinner, and 
a glass or two of brandy and water in the evening, 
over a cigar. This habit may be easily broken, 
and what is of still more consequence, the habit of 



07 INVALIDS FROM HOT CLIMATES. 22 

eating a great deal too much through the day, 
may be readily and salutarily changed into strict 
abstemiousness. 

Bowel-complaint is one of the most common dis- 
eases under which an invalid labours when embark- 
ing for Europe. It is one, too, which is seldom 
cured on the voyage home. After repeated attacks 
of dysentery or hepatitis, the mucous membrane of 
the colon and rectum is actually altered in struc- 
ture, while that of the small intestines continues 
highly irritable for a long time. A large quantity 
of mucus and of very morbid secretions is constant- 
ly poured out from these surfaces, and their irrita- 
bility will not permit the presence of food or faeces, 
as in a healthy condition of the alimentary canal. 
In those who die of dysentery, we find ulcerations 
in the colon and rectum, with thickening and other 
lesions of the coats of these tubes. In those, there- 
fore, who have presented the same symptoms, but 
who have been fortunate enough to survive, there 
is every reason to believe that ulcerations had ex- 
isted, or do exist, as, indeed, has been proved by 
dissection. Ulceration of the intestines may take 
place without any discharge from the bowels, or 
particular pain that would indicate such a serious 
malady, as is proved by finding extensive ulcers in 
the mucous membrane, where death has been occa- 
sioned by fever — and that, too, without any tender- 
ness on pressure of the belly being evinced during 
life. Where there is discharge of mucus, blood, 
and puriform fluid, we may pretty certainly prog- 
nosticate that there is ulceration and other organic 
mischief in the coats of the lower bowels. This 
state will, of itself, keep up chronic diarrhoea or 
dysentery till the parts are restored to a sound con- 
dition — and, even after the structure, becomes sound, 
the function, from long habit, will remain deranged, 
or easily rendered so by very slight causes. 



23 ON THE DISEASES AND REGIMEN 

But anotherand still more-fertile source of chronic 
bowel-complaint is disordered function, or diseased 
structure of the liver; one effect of which is very 
commonly relaxation and irritability of the bowels, 
especially in a tropical climate, and for some time 
after returning to Europe. It is not necessary, in 
this place, to enquire into the reason why the func- 
tion of the bowels should be so generally disturbed 
by disorder of the liver. The fact is well known 
to all who have practised in tropical climates, and 
that is sufficient for the purpose, at present. 

If the bowel-complaint be unaccompanied by he- 
patic affection, and merely kept up by disease or 
disorder in the bowels themselves, the treatment is 
less complicated, both on the passage home and 
subsequently in Europe, than where chronic hepa- 
titis is present. 

In the former case, or simple bowel-complaint, 
the invalid has three-fourths of the treatment, in his 
own hands, or in his own power. Have we any 
remedy to cure a chronic irritation, inflammation, 
or ulceration of the internal surface of the bowels ? 
I believe not. Nature must do this. But we can 
withdraw those things which obstruct nature and 
keep up the disease. If any portion of external 
surface were in the above-mentioned condition, 
what would we do ? The answer is plain. We 
would protect the part from extraneous irritation, 
and give it rest. Nature would do the remainder. 
This rule is equally applicable to bowel-complaints. 
The passage of the remains of our food over the irri- 
table or diseased membranes, lining the bowels, 
causes pain, throws the intestines into increased 
action, and, in fact, produces the phenomena of 
chronic dysentery or diarrhoea. We cannot, it is 
true, prevent this entirely ; but we can live upon 
that kind of food which affords not only the least 
quantity of residue, but the least irritating kind 



OP INVALIDS PROM HOT CLIMATES. 24 

of residue. This object is obtained by living as 
much as possible On farinaceous food, as sago, ar- 
row-root, gruel, tapioca, rice, panada, with animal 
jellies. It is evident that every thing that passes 
the stomach undigested must add to the complaint, 
and, therefore, the quantity of nourishment taken 
in should always be as small as is compatible with 
the support of life. Indeed, as was observed before, 
the less that is taken into the stomach, the more 
will be extracted from it by the digestive apparatus, 
and the more strength we will derive from it. As 
the organs of digestion are, in this complaint, great- 
ly weakened, those substances'which have any ten- 
dency to turn acid are particularly injurious and 
irritating, since the vital powers of the stomach 
and intestines are not sufficient to overrule the 
chemical laws that produce the fermentative pro- 
cess. Hence vegetables and fruit are poison to the 
dysenteric invalid. The drink is also a matter of 
great importance. Wine is almost always injuri- 
ous, and very weak brandy and water is the only 
stimulating potation that should be indulged in. The 
less of this, too, the better. Rice water, with some 
spice, is the best drink ; and as little fluid of any 
kind as possible should be taken into the stomach. 
There is one important item in the management 
of bowel-complaints which is too often overlooked. 
This is, the necessity of 'quietude. It is difficult to 
account for the circumstance, but it is an absolute 
fact, that rest and the horizontal posture are of 
more benefit in dysenteric affections, whether acute 
or chronic, than in many of those spinal diseases 
for which the patient is confined to a hard mattress 
or an inclined plane. The action of the abdominal 
and other muscles sets in motion and augments the 
peristaltic action of the intestines, already in excess, 
and thus hurries along the remains of food, and pro- 
duces many more evacuations than would otherwise 
C 2 



25 ON THE DISEASES AND REGIMEN 

take place in a state of quietude. The tropical in- 
valid, therefore, should not be gadding about the 
decks on the voyage home, but confine himself a 
good deal to his cot or his cabin, and, in wet or 
blowing weather, he should not attempt to go from 
below, unless compelled by unavoidable circum- 
stances. 

As the temperature of the ocean is, at all times, 
much below that of the land, in the hot season, the 
invalid should guard the skin most scrupulously 
from all assaults of moisture or cold air. If this be 
not attended to, the bowel-complaint will be exas- 
perated instead of amended on the homeward voy- 
age. The belly should be bandaged pretty tightly 
with a very long flannel roller, which will prove 
not only a defence from cold and humidity, but it 
will curb the action of the abdominal muscles, and 
tend to keep the intestines quieter. Food and 
drink should not be taken either very hot or very 
cold. The former excites the bowels almost im- 
mediately ; and the latter causes pain in the sto- 
mach and colic in the intestines. 

But is there nothing to be done in the way of 
medicine? Yes, provided the medicinal treatment 
be aided by the strictest attention to diet and regi- 
men, as sketched out here. We cannot by direct 
remedies heal chronic ulcerations, thickenings, or 
other morbid affections of the intestines ; but we 
can greatly assist nature in preventing and remov- 
ing various sources of irritation ; and we can lessen 
the morbid sensibility or irritability of the bowels 
themselves, and thus check the increased discharges 
from them. 

The two principal sources of irritation are, the 
remains of food passing along an irritable or actually 
diseased surface, and acrid or morbid secretions, 
coming from the liver, the pancreas, and the glands 
and follicles of the intestines themselves. I have 



OF INVALIDS FROM HOT CLIMATES. 26 

already hinted at the means of lessening the irrita- 
tion of faecal matters, by strict attention to the quan- 
tity and quality of food taken into the stomach. If 
this point be attended to, much of the inconve- 
nience from morbid secretions will be prevented; 
for there is not a more certain method of rendering 
the secretions acrid and diseased, than by eating 
and drinking more in quantity than can be well di- 
gested and disposed of; or things of a quality 
known to disagree with irritable bowels. 

For the improvement of the biliary secretion, 
much may be done by medicinal treatment. As 
there is generally some degree of low inflamation 
or congestion about the liver, a few ounces of blood 
taken from the neighbourhood of that organ, once 
in a fortnight or three weeks, will be of essential 
benefit — especially if there be pain or tenderness on 
pressure under the false ribs. The counter-irrita- 
tion of an occasional blister, or, what is better, a 
tarter-emetic plaster to the region of the liver, will 
be found a useful item in the treatment. Very mi- 
nute doses of the mildest mercurial, particularly the 
hpdrargyrum cum creta, or the blue pill, combined 
with a small quantity of ipecacuan, and a drop or 
two of essential oil, every night, will be necessary, 
even if long and repeated courses of mercury have 
been previously endured. For it is to be recollect- 
ed, that the same remedy which fails, or only parti- 
ally succeeds, where the causes of hepatitis are in 
constant operation, will be often successful when the 
individual is withdrawn from the sphere of these 
causes, and enjoys the pure air of the ocean, or the 
genial influence of his native skies. But a mild 
mercurial is necessary, as an alterative, and to keep 
up some degree of healthy action in an organ that 
has been long stimulated by the heat of India, and 
by large doses of the same medicine, unavoidably 
exhibited to prevent destruction of the biliary ap- 
paratus. 



27 ON THE DISEASES AND REGIMEN 

As ascidity is a common symtom in chronic 
bowel-complaints, so alkaline and absorbent medi- 
cines are daily and almost hourly necessary, till the 
digestive organs have acquired more power over 
the food taken in. Three to five grains of the car- 
bonate of soda, with an equal quantity of the com- 
pound cinnamon powder, three or four times a day, 
will be a useful antacid, and will cut off one source 
of irritation. 

On the other hand, rancidity is apt to prevail 
where oily or fat substances are taken into the sto- 
mach. We cannot qualify this so readily as acidi- 
ty. We should avoid the cause. A bitter spiritu- 
ous tincture is the best thing to check rancidity 
when it has taken place. 

Acrid, acid, and rancid matters, however, are so 
quickly and so constantly generated in the bowels, 
that we are forced to expel them by aperient medi- 
cines, even at the time when the intestines are re- 
ally too often acted on. The relief that follows this 
forcible expulsion of morbid secretions has induced 
both patients and practioners to have too much re- 
course to purgative, both in acute and chronic bow- 
el-complaints. They give relief in two ways — by 
removing irritating matters, and by lessening, for a 
time, irritability itself. Any strongly acting pur- 
gative will, as it were, exhaust the irritability of 
the nerves of the mucous membrane, and a tempo- 
rary insusceptibility to impressions is the natural 
consequence. But this method should be cauti- 
ously employed, and other means are preferable. 
Castor oil, rhubarb, and the milder aperients, not 
too often repeated, are much better than doses of 
calomel and ; black-draught, whatever may be the 
degree of comfort experienced after these last medi- 
cines. Thin injections of gruel and oil, with some 
laudanum, are very useful, not only in allaying ir- 
ritability of the rectum and colon, but of washing 



OF INVALIDS FROM HOT CLIMATES. 28 

away the remains of irritating secretions from these 
parts. Whenever we exhibit purgatives in this 
complaint, we should combine with them some 
slight anodyne — especially the extract of hyoscia- 
mus or lettuce. This is a precaution too little at- 
tended to. 

So much for the correction of irritation resulting 
from diseased secretions. But we must remember 
that there is a morbid irritability of the mucous 
surfaces of the stomach, and especially of the bow- 
els, in consequence of which, things that, in health, 
would produce no sensation, much less inconve- 
nience, cannot now be borne without great, discom- 
fort. This state often obtains where no inflamation, 
no ulceration, no organic or perceptible change of 
structure in the parts themselves, has yet taken 
place, or remains after having one existed. Such 
condition appertains to the nerves of the digestive 
organs, and can only be remedied through the ner- 
vous system. There are many ways of diminishing 
morbid nervous irritability — I say morbid, because 
those things which decrease morbid irritability or 
sensibility, will not always decrease natural or 
healthy irritability. I have remarked on one of the 
classes of means we are to use — the subduction of 
irritating food, and the correction or removal of irri- 
tating secretions. The direct reduction of morbid 
sensibility in the intestines is generally attempted 
by direct sedatives or anodynes — of which opium 
stands at the head. Without this valuable medicine, 
we can seldom succeed in the bowel-complaints of 
hot climates; but its use is attended with much in- 
convenience in many constitutions, and we should 
endeavour to make as little as possible serve the pur- 
pose of quieting the bowels, and lulling the sensi- 
bilities of their nerves. From half a grain to a 
grain of opium, combined with two or three of hyo- 



29 ON THE DISEASES AND REGINEN 

sciamus, a grain of blue pill, and half a grain of ipe- 
cacuan, will be found very beneficial every night at 
bed time, continued for a considerable time, while, 
every second or third day, a small dose of castor oil 
may be advantageously taken to remove any hard- 
ened faeces, or diseased secretions from the cells of 
the colon, in which they occasionally lurk, and keep 
up irritation in the whole line of the bowels. 

When the invalid is harrassed through the day 
with frequent motions, consisting principally of sli- 
my mucus, and attended with straining and tenes- 
mus, he should keep as quiet and horizontal as pos- 
sible, and take a spoonful of the following medicine 
after every relaxed motion. 

J& Pulv. Cretan comb. 3j. 

Confect. Aromat. . 3j. 

Tinct. Rhei, . . gij. 

Opii, . . 3j. 

Mucilaginis Acacias, gss. 

Syr. Zingib. . . gij 

Aquae Cinnamomi. ^iv. 

Misce, fiat mistura, capiat coch. j. mag. post singu- 
lam sedem liquidam. 

If the opium disagree, the tincture of hyosciamus 
may be substituted ; but it is not so efficacious in 
restraining the discharges from the bowels. 

There are many other medicinal substances which 
lessen morbid sensibility of the bowels besides 
those of the anodyne or narcotic class. It has long 
been known that debility is the parent of irrita- 
bility. This is obvious to the most superficial ob- 
server. A familiar example is seen after all acute 
or inflammatory diseases. During the height of the 
fever or inflammation, for instance, the general ex- 
citement of the system prevents the feeling of weak- 
ness; but as soon as the excitement subsides, the 



OF INVALIDS FROM HOT CLIMATES. 30 

patient is then sensible of his exhaustion, and be- 
comes proverbially irritable. Nurses and other at- 
tendants on the sick, are aware that this irritability 
is a sign that the disease is subsiding or subsided, 
and always consider it as a favourable symptom. 
Now what applies to the whole, applies also to a 
part. Wherever local disease has been established, 
and the structure or functions injured, there will be 
debility and irritability. By removing the/br??zer, 
we shall generally mitigate the latter. Tonics, 
therefore, when they can be borne, and where they 
do not induce too much excitement, are valuable 
means of blunting the morbid sensibility of the 
nerves. But their bulk often proves a source of ir- 
ritation to the stomach and bowels, hence the sul- 
phate of quinine, properly managed, is superior to 
all others, on account of its vast efficacy in so small 
a form. It is generally given in doses too large, 
by which an excitement is produced that renders it 
necessary to discontinue the medicine. The follow- 
ing form will be found an admirable mode of ad- 
ministering this remedy in chronic dysentary and 
diarrhoea. 

Jk Tinct. Gentianae c. . . ^iss. 

Zingiberis . . . 

Camphorae Comp. aa gij. 

Sulphatis Quininae . gr. x. 

ft. solutio, capiat coch. j minut. ter die, ex pauxillo 
aquae tostae. 

The principal inconvenience that I have found to 
result from this remedy, is the increase of appetite, 
which soon follows, and which may induce the pa- 
tient to indulge too freely in food. He ought to be 
put on his guard against this danger. The improve- 
ment in the state of digestion that results from the 
operation of this preparation on the stomach, will 



31 ON THE DISEASES AND REGIMEN 

greatly conduce to the removal of irritation from 
the bowels, of which undigested food is a common 
source. Independent of this, the quinine will be 
found, thus managed, to give tone to the whole line 
of the mucous membrane — to restrain the mucous 
discharges, and thus to directly lessen morbid sensi- 
bility in the nerves of these parts. 

I am not a friend to common astringents in the 
bowel-complaints which follow diseases and resi- 
dence in hot climates. The mucous discharges are 
thus rudely stopped, and a sub-acute inflammation 
of the membrane from whence it issued, or of the 
liver itself, is not an unusual consequence. It is far 
better to withdraw irritation and reduce morbid 
sensibility — the causes of the increased discharges — 
than to strike at the branches while the root remains 
untouched. The farrago of astringent substances 
that have been employed to restrain dysenteric and 
hepatic flux, are worse than useless, and the prac- 
tice of applying them, is built on an erroneous foun- 
dation.* If the means which I have pointed out 
should fail, it is highly probable that a gentle mer- 
curial course will be necessary, either on the voy- 
age home, or soon after gaining the shores of Eu- 
rope. This course, as I have hinted before, will 
often effect a cure, where long and repeated courses 
of mercury, beneath a tropical sun, and in a land 
that produces the causes of the disease, may fail, or 
give only temporary relief. The mouth, however 
should not be made sore while rounding the Cape, 
especially if that part of the voyage be made in 
June, July, or August, when wet and cold weather 

* Within these two or three years, I have seen some extraordi- 
nary good effects, in chronic irritability of the bowels, from small 
doses of the lunar caustic taken internally — namely, half a grain 
to a grain twice a day. We know the efficacy of this application 
externally, in lessening the irritability of sores, and I conceive that 
it acts in the same manner internally. 



OP INVALIDS FROM HOT CLIMATES. 32 

may be expected. Advantage should be taken of 
the milder and lower latitudes, near the Equator, if 
it be deemed indispensable to impregnate the system 
with mercury. 

But, however this may be, as the tropical invalid 
approaches the shores of England, he should protect 
the skin, by all possible care, from chills or damp. 
The atmospheric influence will reach him in spite 
of all precautions ; but if he rashly exposes himself 
to the skies of this country, after a long residence 
in the torrid zones, especially if labouring under 
bowel or pulmonic complaint, he will be in danger 
of serious aggravation of his malady. 

Before quitting the subject of the homeward- 
bound voyage, I cannot help saying a few words 
more on a topic which has been already touched 
on — namely, those affections of the chest which are 
originally induced by disease of the liver, or of the 
digestive organs generally, and which have been 
called "dyspeptic phthisis/' " stomach-cough," &c. 
Many valuable lives are annually lost by treating 
these complaints as purely symptomatic, when they 
have actually become fixed diseases in the lungs or 
other parts within the chest. When the disease has 
passed the boundary, and become independent of 
its original cause, which it not unfrequently does, 
then I maintain, from the most unquestionable evi- 
dence, that it is aggravated rather than alleviated 
by the remedies employed for the cure of the origi- 
nal complaint. Modern investigations (ausculta- 
tion and percussion) have now given us the means 
of ascertaining with the greatest accuracy, whether 
there be or be not organic affection of the lungs or 
heart. The medical practitioner, therefore, who 
has the charge of the invalid on the voyage, or who 
first sees him on his reaching Europe, should not 
neglect to examine the chest most scrupulously, 
wherever there is cough, difficulty of breathing, or 
D 



33 ON THE DISEASES AND REGIMEN 

irregularity in the circulation; and, if any disease be 
detected there, the hepatic or stomach affection 
should be made quite a secondary consideration, 
and every effort should be used to remedy the more 
dangerous malady that has supervened. A few 
days exposure to a cold or variable atmosphere may 
render the latter incurable, and therefore, seclusion 
in a regulated temperature should be enjoined, while 
local bleeding, blistering, and antimonials, are sub- 
stituted for mercurials and other measures pursued 
for the cure of the abdominal disorder. The inva- 
lid should be recommended to confine himself to 
his cabin, if on the voyage; or within doors, if land- 
ed, in the most sheltered situation which the coun- 
try can present. It is really lamentable to see men 
returned from a tropical climate, walking about the 
streets of London, or going to places of amusement 
in the cold raw evenings of winter, while the hack- 
ing cough, emaciated figure, and variegated coun- 
tenance, proclaim a condition of the lungs which 
ill comports with this exposure to the vicissitudes of 
a northern climate. 

The pulmonic affection which is caused by and su- 
pervenes on derangement of the liver and digestive 
organs, may occasionally be discriminated, especially 
in the early stage, from that which commences origi- 
nally in the chest, and proceeds from scrofula, or 
phthisical disposition of the constitution. The cough 
is at first dry, or only accompanied by a trifling expec- 
toration of mucus ; the spirits are more depressed ; 
the countenance more sallow than in the idiopathic 
forms of pulmonary disease. The paroxysms of 
cough are generally after eating, and early in the 
morning; and lying over on the left side is apt to 
excite cough when in bed. 

In the progress of the disease, the expectoration 
becomes more copious, and, from being limpid or 
glairy, begins to exhibit some suspicious points of a 



OF INVALIDS PROM HOT CLIMATES. 34 

Eurulent character. This last character gradually 
ecomes more predominant, as the disease advances, 
and occasionally some streaks of blood are seen. In 
the commencement of the disease, and consequently 
where the cough and other phenomena are merely 
symptomatic of disorder in another quarter, the pa- 
tient can expand his chest, and go up an ascent with 
much less breathlessness than in cases where phthis- 
is is advancing in consequence of a previously tu- 
berculated state of the lungs. In the dyspeptic 
pulmonary affection, in short, it is the mucous mem- 
brane which is generally engaged, especially at the 
begining, and, therefore, the pulmonary structure 
Is previous to the air. In the more advanced sta- 
ges, the parenchymatous tissue of the lungs becomes 
condensed, or hepatized ; and the mucous mem- 
brane of the trachea and bronchia organically chang- 
ed, so as to throw out puriform matter. If there 
be any disposition to scrofula or tubercles, this dis- 
position is likely to be excited into action by the 
sympathetic irritation, and then phthisis, of the com- 
mon and fatal kind, will soon be developed. 

In this insidious and dangerous symptomatic dis- 
order of the chest, there is often little or no pain in 
any fixed point; but there is not unfrequently an 
uneasy sensation under the sternum ; or a dull pain 
at the pit of the stomach ; or fugitive pains, appa- 
rently of a muscular character, m various parts of 
the thorax, or even in the limbs, the spine, &c. It 
is probable that these are referrible to the disorder 
of the digestive organs rather than to the affection 
of the respiratory apparatus. The feyer does not 
take on the regular hectic form so early in the dys- 
peptic as in the idiopathic phthisis ; nor is the ema- 
ciation so rapid. 

It will he evident to the medical practitioner that 
these are only modified symptoms of idiopathic 
pulmonary disease, and consequently offer no cer- 



35 ON THE DISEASES AND REGIMEN 

tain criterion that the disease is symptomatic of 
derangement of the digestive organs. The presence 
of this last derangement, however, as indicated by 
flatulence, irregularity of bowels, diseased secre- 
tions, furred tongue, loss of appetite, tenderness and 
fullness of the epigastrium, and a host of nervous 
and hypochondriacal phenomena, will strengthen 
the diagnosis. But the grand object is to determine 
the period when symptomatic disorder is passing 
into the state of actual disease ; and this, I main- 
tain, cannot be done by any investigation of symp- 
toms, however minute, short of exploration of the 
chest by means of auscultation and percussion. 
Yet, on this distinction between the two states, the 
whole question of treatment hinges. 

Dr. Philip has divided this disease into four sta- 
ges, in which, he acknowledges, the prognosis and 
mode of treatment are different. I mo - The pulmo- 
nic affection is merely sympathetic, and ceases with 
the removal of its cause. This stage is short in du- 
ration, mild in symptoms, and accompanied by no 
expectoration, except some phlegm with the cough. 
2ndo. The sympathetic has .produced actual disease 
in the lungs, indicated by some degree of inflamma- 
tion in the bronchia, and admixture of pus-like sub- 
stance in the expectoration, somtimes blood. The 
tendency to fever is now greater, yet seldom in the 
hectic form. It is at this period, Dr. Philip thinks, 
that tubercles begin to form. But,-at the time Dr. 
P. wrote, we had not the means of ascertaining this 
circumstance, or, in fact, of knowing what were the 
organic changes that might be commencing or mak- 
ing progress in the lungs ; nay, we had not the 
means of saying whether organic change had actual- 
ly begun. Hence the diagnosis was mere guess- 
work. The ulterior stages are the same as in idio- 
pathic phthisis, and on these it is unnecessary to 
remark. Dr. Philip says, that it is after fulness 



OP INVALIDS FROM HOT CLIMATES. 36 

and tenderness have taken place in the epigastric 
region, that the derangement of the digestive organs 
affects the pulmonary function. ButTiow long after, 
or when it begins to affect the pulmonary structure, 
neither he nor any man can tell without the means 
alluded to, which is only a discovery of very recent 
date. Without this investigation then, we may be 
too early in our treatment of the pulmonic affection, 
or too late. The former error is dangerous ; but 
the latter is fatal to the patient. If auscultation 
were attended with no other advantage than this 
discrimination of the two stages of dyspeptic phthis- 
is, (a disease so very prevalent in this country,) it 
would be the most valuable discovery of the pre- 
sent century. 

The treatment of the first stage of this disorder 
will be almost entirely directed against the hepatic 
and gastric affection on which it depends, and which 
will be fully detailed farther on. But even in this 
stage, much may be done by regimen, attention to 
dress, and regulation of temperature, in saving the 
organs of the chest from any increase of disorder in 
their function, or risk of change in their structure. 
This attention cannot injure the dyspeptic disorder, 
but, on the contrary, contribute to its removal ; 
while a neglect on this point may allow a sympto- 
matic to change into an organic disease, when the 
chance of recovery must be small indeed. 

So few opportunities are afforded of ascertaining 
the state of the lungs, by dissection, in the early 
stage of stomach cough, or dyspeptic phthisis, (as it 
has been improperly called, for in the early stage it 
is not phthisis at all,) that we have no other means 
of knowing what is passing, than by auscultation 
and percussion. In those cases where the cough is 
purely symptomatic, and where there is no other 
disease of the chest, the sound will be clear in all 
parts, and the air will be heard permeating the pa- 
D 2 



37 ON THE DISEASES AND REGIMEN 

renchyma of the lungs in every direction. In se- 
veral instances where I have lately examined the 
chest, and where there were only the phenomena 
of sympathetic affection, I have found some por- 
tions of lung, especially in the left side, where no 
respiration could be heard, and where the sound 
was quite dull. By blistering, antimonials, colchi- 
cum, and seclusion, these points have regained their 
integrity of function, and the sound has returned. 
Hence I am led to conclude, that one of the first 
changes that take place, where symptomatic is pas- 
sing into structural disease, is a condensation of the 
parenchymatous substance of the lungs, by no means 
incompatible with restoration. It is probable, how- 
ever, that the very first change is that of irritation 
of the mucous membrane of the trachea and bron- 
chia into a low kind of inflammation, with a cor- 
responding change from a dry cough to one with 
some slight expectoration. Condensation or hepa- 
tization, as it is called, is probably the next change, 
and this supposition is, I think, strengthened by the 
fact, as ascertained by the stethoscope, that hepati- 
zation is the most common of all organic affections 
which we find in the lungs of people somewhat ad- 
vanced in dyspeptic phthisis. In the ulterior sta- 
ges, the lungs present, of course, on dissection and 
auscultation, the same phenomena as in regular 
idiopathic phthisis, so widely prevalent and so des- 
tructive in this country. 

I shall adduce no more reasons than are pointed 
out above, why the medical attendant should minute- 
ly examine the state of the chest, where cough has 
supervened on disorder of the digestive organs. A 
deiusive hope that the former may be safely over- 
looked, and that its removal will follow, as a matter 
of course, the improvement of the hepatic and di- 
gestive functions, may very often cause the practi- 
tioner a world of chagrin afterwards, when he finds 



OP INVALIDS FROM HOT CLIMATES. 38 

his patient getting worse, and when an alteration in 
the treatment and prognosis will betray an error 
in the first diagnosis which was formed. Whereas, 
by careful examination of the chest, in the first in- 
stance, he will be enabled to form a more correct 
opinion, and consequently to give a more guarded 
prognosis ; circumstances that will be very useful 
to him, should the disease take a serious turn in the 
sequel. 

Should an examination of the thoracic organs 
shew the existence of organic disease in the lungs, 
no time should be lost in sending the patient to the 
most beneficial atmosphere, where the temperature 
should be regulated, and every possible means em- 
ployed to arrest the progress of disease in the lungs. 
So much difference of opinion prevails respecting 
the climates of France and Italy, that it is difficult 
to say where the patient should go. If other things 
were equal, Nice or Naples would appear to afford 
a fairer prospect than the gloomy skies of England; 
at least before any purulent expectoration appears. 
When a breach of structure is once made in the 
lungs, a warm climate can do no good, but rather 
increases the evil. 

When puriform matter begins to issue from the 
lungs, whether from broken-down tubercles, a com- 
mon vomica, or a diseased surface of mucous mem- 
brane, I apprehend a great revolution is about to 
take place in the general treatment. From several 
cases which have lately been under my own care, I 
am confident that the tonic plan, combind with lo- 
cal depletion and counter-irritation, is infinitely su- 
perior to the asses milk and hermit's diet on which 
the phthisical patients are usually kept. In exter- 
nal scrofulous sores, our great object is to improve 
the general health, and increase the general strength, 
and why should not the same plan be pursued when 
there is an internal abscess ? I fear we have too 



39 ON THE DISEASES AND REGIMEN 

often confounded the fever of irritation, or, in other 
words, the phenomena of hectic, with inflammation, 
and that the means used to subdue this fever have too 
often increased it. Three cases lately fell under 
my notice, where the expectoration was purulent 
— the pulse ranging from 110 to 140 — with hectic 
fever and perspirations, and, in short, all the symp- 
toms of established phthisis; and yet where the 
whole of these phenomena disappeared under the 
administration of the sulphate of quinine in well 
acidulated infusion of roses, aided by light animal 
food ; sponging the chest twice a day, with tepid 
vinegar and water; and obviating pain in the chest 
by blisters, antimonial ointment, and occasional 
leeching. This, too, was done without any other 
air than that of London, Pentonville, and Bromp- 
ton.* But it would be out of place to pursue the 
subject of pulmonary disease any further, as another 
class of human maladies, to which the tropical in- 
valid is peculiarly prone in his native climate, is 
now to be considered. Before entering on this ex- 
tensive and difficult subject, however, I must dwell 
a little on — 



ORGANIC DISEASE ON THE LIVER. 



I may venture to assert, from pretty ample ex- 
perience, that not one in ten of those who are sup- 
posed to labour under "chronic liver disease," 

* The air of Brompton, by the way, is peculiarly mild and agreea- 
ble in pulmonic affections, as the Londoners well know, who send 
their children out there when labouring under whooping-cough; 
and who resort thither themselves, when affected with pulmonary 
complaints. It is protected from the easterly and northerly winds 
by London itself, and by the hills of Pentonville, Highgate, and 
Hampstead. It is open to the South and West ; and is, upon the 
whole, the mildest air in the vicinity of the metropolis. 



OF INVALIDS FROM HOT CLIMATES. 40 

as it is termed, on their return from hot climates, 
have any organic affection of that viscus, which can 
be detected by the most minute examination. It is 
really astonishing how many people are deceived — 
medical men as well as their patientsre — specting 
enlargements and indurations of the organ in ques- 
tion. There are very few who labour under de- 
rangement of function in the liver or digestive ap- 
paratus, who have not tenderness on pressure, and 
an apparent fulness iu the epigastric region, and 
under the false ribs of the right side. These symp- 
toms alone are quite enough, in some men's minds, 
to entitle a tropical invalid, in particular, to the 
honour of having "chronic hepatitis," with en- 
largement of the organ. Yet, in nine instances out 
of ten, there is no such thing as organic disease in 
the case. The tenderness in pressure, is infinitely 
more common where there can be no suspicion of 
organic disease of the liver, than where this last 
is palpable to every eye. It is very common in the 
lighter shades, as well as in the higher decrees of 

dyspepsia, ana arises from morbid sensibility in the 
nerves of the stomach and bowels, far more fre- 
quently than from change of structure either in the 
liver or other contiguous organs. It is very often 
present even where there is no functional affection 
of the above-mentioned viscera ; but where there is 
an irritable state of the mucous membrane of the 
colon, where it sweeps round under the liver and 
false ribs: nay, I affirm that this tenderness of the 
epigastrium, to which so much undue importance 
is attached, may, at any time, be induced by a dose 
of purgative medicine that irritates the mucous 
membrane of the colon. There is, in fact, at all 
times, and in all people, even in the highest health, 
a greater or less degree of tenderness on pressure 
at the pit of the stomach, most probably owing to 
the vicinity of the great semilunar ganglion, or 



41 ON THE DISEASES AND REGIMEN 

solar plexus, the sensorium of the abdominal vis- 
oera. What school-boy does not know how easily 
he may be what is called " hearted" by a slight 
blow in that region ? I repeat it, then, that tender- 
ness, in epigastrio, is an exceedingly fallacious sign, 
and no criterion at all of organic disease in the 
parts underneath. 

This natural tenderness at the pit of the stomach 
leads to another error very commonly committed 
— namely, the belief that an enlargement of the 
liver exists. The moment that the fingers of the 
physician or surgeon are thrust against the parietes 
in this region, the abdominal muscles are thrown 
into action, and one of the rigid bellies of the rec- 
tus, on the right side, is every day mistaken for the 
edge of the liver. Of this mistake I have seen nu- 
merous examples. No accurate judgment can be 
formed till the patient is placed in such a position 
as entirely relaxes the abdominal muscles. In 
some people, indeed, it is almost impossible to get 
these muscles relaxed in any position, while under 
examination ; m iney a7G voluntarily or involuntari- 
ly thrown into action the moment the fingers are 
applied to these parts. And, after this relaxation 
is obtained, a loaded state of the colon, no uncommon 
occurrence, will often deceive the incautious prac- 
titioner, and lead him to think he has discovered an 
indurated liver, which, in a few days, disappears 
under the use of aperient medicines. 

In respect to fulness of the epigastrium, there is 
much misconception. In corpulent people, no de- 
pendence can be placed in this symptom; while, in 
lean people, and especially in people who have be- 
come emaciated, as is often the case, the fulness 
in more apparent than real. In fact, in almost all 
people who are naturally thin, or emaciated by ill 
health, there is an apparent fulness in the epigas- 
trium while in the erect posture, produced by the 



OP INVALIDS FROM HOT CLIMATES. 42 

shrunk state of the abdomen. In some individuals 
the stomach is much larger than in others, and any 
distention of this organ, by food or flatus, will give 
an unnatural appearance of fulness to this region. 

Pain in the region of the liver, or, indeed, in 
the " right side," is another symptom which leads 
many astray. The biliary organ occupies a large 
space, and is surrounded by other organs and struc- 
tures much more susceptible of pain than itself. 
The intercostal and other muscles, the stomach, the 
duodenum, and different contiguous parts, are far 
oftener the seat of pain than the liver itself ; and 
even when the seat of pain is in the biliary appara- 
tus, it is more frequently in the gall-bladder or 
ducts than in the substance of the organ. But pain 
is no proof of organic disease in any part of the 
body. The most painful disease to which the hu- 
man fabric is subject, tic douloureux, is unaccompan- 
ied by any visible change in the part, and often has 
its cause at a great distance from its apparent seat 

In respect to a symptom which has been, time 
immemorial, considered as pathognomonic of liver 
disease — pain at the tip of the right shoulder — 
I acknowledge that it does, in a certain proportion 
of cases, exist. But'from what I have myself seen, 
and from an examination of the records of cases 
where dissection proved the existence of organic 
disease in the liver, I am confident that this symp- 
tom does not accompany one twentieth of the dis- 
eases in question ; and that, when it does obtain, it 
is far more frequently an accompaniment of disor- 
dered function than disease of structure. Neither 
is this pain so generally in the tip of the shoulder 
as is supposed. It is very often seated in the in- 
ferior angle of the scapula, nay, still lower down 
among the long muscles of the back. I have 
known it to continue long and troublesome, where 
the functions of the liver were but little affected, and 



43 OF THE DISEASES AND REGIMEN 

where the case was evidently dyspepsia, .dependent 
on irritability of the nerves of the stomach and up- 
per bowels ; and it has disappeared under the use of 
medicines directed entirely to the dyspepsia. Why 
this part should be more frequently the seat of this 
sympathetic pain than other parts of the body, is by 
no means accounted for by any particular distribu- 
tion of nerves. True it is, that there is no spot on 
the surface of the body, the nerves of which do not 
communicate, directly or indirectly, with the 
nerves of all other parts ; but this does not account 
for the peculiar courses and directions in which 
sympathies run. Thus, tic douloureux, when de- 
pendent on irritation in the digestive organs, takes 
its seat very generally on one side of the face — for 
which no satisfactory reason can possibly be given. 

Pain, then, whether in the region of the biliary 
apparatus, in the shoulder, or in the back, is no 
criterion of organic disease of the liver. It is more 
frequently absent than present in such diseases, and, 
when present, it is more commonly dependent on 
disordered function of the liver or stomach, than 
on changes of structure in either of these organs. 

This symptom, by the way, is rather a sense of 
burning or aching, than actual pain. It is more 
felt when exercise is taken than when the indivi- 
dual is quiet, and is very generally increased when 
the stomach is more than usually out of order, or 
when any temporary irritation of mind is kindled up. 

These are some of the principal sources of fallacy 
in regard to organic diseases of the liver, and ofte#. 
lead to unnecessary courses of mercury and other 
medicines, that, at least, do no good, but sometimes 
much harm. 

What evidence, then, it may be asked, have we 
of change of structure in the biliary apparatus ? If 
this organ can be felt protruding below the ribs, we 
can say it is enlarged, but of what that enlargement 



OP INVALIDS FROM HOT CLIMATES. 44 

consists no pathologist can tell, unless he speak by- 
guess. It may be tubercles, it may be interstitial 
deposit sin the parenchymatous structure, of various 
kinds and consistencies, or hypertrophy of the pa- 
renchyma itself, it may be hydatids, &c. but the 
scalpel alone can unravel the true nature of the dis- 
ease, and then it is little consolation to the owner of 
the organ, even should its portrait form a beautiful 
and expensive plate, or the diseased mass be pre- 
served in that fluid which destroyed its original 
texture, and life itself. 

Of the various changes of structure which dis- 
section has shewn in the livers of those who have 
sojourned in hot and unhealthy climates, an en 
largement, generally with induration, of the paren- 
chymatous structure of the organ, is by far the 
most common. Whether this increase of volume 
be owing to simple increase of the natural structure 
(hyperthrophia or reproduction, as it is called by 
some foreign writers) or to an interstitial deposit of 
fatty, albuminous, or other animal material, admits 
of some doubt. That the liver, like the heart, 
may become magnified by multiplication, as it were, 
of its own natural substance, is by no means im- 
probable ; since we every day see livers of immense 
size, but of apparently healthy, or at least homoge- 
neous structure, in the bodies of those who betrayed 
no symptoms of the liver disease during life. But, 
in the great majority of those who have evinced 
derangement of function and increase of size in the 
biliary organ, we find a variegated appearance in 
the structure after death, proving an interstitial de- 
posit, which I conceive to be the most common 
cause of the enlargement. To the other morbid 
growths, as tubercles, hydatids, &c. the tropical in- 
valid is not more subject than his countrymen at 
home. 

There is yet another organic disease of the liver, 
E 



45 ON THE DISEASES AND REGIMEN 

more common in this country than in hot climates ; 
which consists of a diminution and condensation of 
the parenchymatous structure with a corresponding 
inefficiency of function, and a long train of symp- 
toms which will be noticed farther on. 

The above are the principal changes which the 
biliary apparatus undergoes during life, and which 
can only be ascertained by the knife after death. 
But, it will be asked, " can we not tell by the 
symptoms what is the organic change going on?" 
I venture to assert that we cannot. Since little can 
be learnt from external examination, in respect to 
the kindoi structural disease in the liver, we have 
only the disorder of function, and its consequences 
on the constitution, to guide us, and I unhesitat- 
ingly aver, that disorder of function in the biliary 
apparatus is often more considerable where there is 
no change of structure, than where there is 
organic disease of great and irremediable magnitude. 
This is so much the case, that, when I find much 
functional disturbance in the biliary secretion, and 
much constitutional derangement resulting thence, 
I conclude (unless there be tangible enlargement) 
that the structure of the liver is unaffected in any 
material degree. 

The symptoms which afford the greatest proba- 
bility of organic disease in the liver, (supposing 
that no tangible enlargement is present, for then 
the ease is unequivocal,) are wasting of the body, 
a peculiar sallow and unhealthy aspect of counte- 
nance, permanent yellowness of the skin, derange- 
ment of the stomach and bowels, and dropsical ef- 
fusions. None of these symptoms are certain cri- 
teria, nor even the whole of them combined, they 
merely afford presumptive proof. They may all, 
even the permanent jaundice, exist, where the scal- 
pel can detect no material change of structure.* 

* Cases of permanent jaundice are on record, where no organie 
disease of the liver or obstruction of its ducts could be found after 



OP INVALIDS FROM HOT CLIMATES. 46 

The morbid condition of the bile, or, in other 
words, disordered function of the liver, is, as I 
observed before, much more conspicuous and se- 
vere in many cases where there is no change of 
structure, than in cases where the enlargement of 
the liver is unequivocal, and the whole organ full 
of tubercles or other morbid growths. This is hard- 
ly credible; but it is a fact. I have seen motions, 
day after day, and week after week, containing the 
most healthy-looking bile, where the liver reached 
as low as the umbilicus, and was found after death 
a mass of disease ; while, on the other hand, every 
practitioner must have seen patients passing, for 
months in succession, or rather for years, the most 
depraved biliary secretion, ceranging the functions 
of all the abdominal organs and powerfully disturb- 
ing the health, where no organic disease could have 
existed, 6ince all these symptoms have been found 
to vanish suddenly, under the influence of proper 
medicine, diet, and pure air. 

In fine, we have no eertain mark of organic dis- 
ease of the liver, but tangible enlargement of its 
substance, and then, no certainty of the precise na- 
ture of the morbid structure — all the disorders of 
its function, and the consequences of these disor- 
ders on the general health, being found infinitely 
more often without than with any cognizable 
change in the organization of the biliary apparatus. 

This investigation or analysis of diagnostic symp- 
toms, is of the utmost importance in a practical 
point of view, for it narrows the treatment into two 
principal indications — that which is designed for the 



death. Such cases, however, are very rare ; and permanent jaun- 
dice may generally be set down as dependent on some tumour in 
the liver pressing on the bile ducts, and causing regurgitation, or 
absorption of the bile into the circulationo 



47 ON THE DISEASES AND REGIMEN 

reparation of diseased structure, and that which is 
directed to the correction of disordered function.* 

Diseased Structure. As I have already shewn 
that we have no certain proof of diseased structure 
in the liver, except by its tangible enlargement, so 
it is to this state that I confine myself on the pres- 
ent occasion ; for this criterion being absent, all we 
can aim at is the improvement of disordered June* 
Hon, which will be fully treated of afterwards. 

Have we any, and what methods of removing en- 
largement of the liver, including various kinds of 
morbid growth ? That simple enlargement of this 
organ is often removed by proper means, there 
can ,be no doubt ; but that we have much power 
over tubercular or hydatid growths, is very ques- 
tionable. In all kinds of enlargement, however, 
one great object is to cut off as much of the supply 
by which the morbid growth is fed, as possible, 
and the next is to promote the absorption of what 
has already taken place. There can be very little 
doubt that, in most morbid growths, both in the liver 
and elsewhere, there is more or less increased ac- 
tivity of the blood-vessels of the part, or, in other 
words, inflammation, generally of the chronic kind. 
This slow or chronic hepatitis, by which the biliary 
organ is ultimately changed in structure, with in- 
duration and enlargement, shews itself more by de- 
rangement of function in the organ itself, and in 
those organs with which it is associated in office, 

* Inflammation, acute or chronic, and irritation, are rather to be 
considered the morbid processes by which structure is changed, and 
function disordered, than the organic and functional affections 
themselves. It would uot be proper to say that a man labours un- 
der organic disease of the lungs because ne is affected with pneu- 
monia, though the pulmonic inflammation may terminate in or 
produce disorganization, And, on the same principle, I do not 
class hepatitis, acute or chronic, among the organic changes in the 
liver, though it leads to those changes. 



OF INVALIDS PROM HOT CLIMATES. 48 

together with a number of anomalous symptoms in 
the constitution at large, than by those symptoms 
which are common to slow inflammation in other 
structures of the body. We must not expect to 
find quickness of pulse, heat of skin, thirst, and 
other inflammatory phenomena, attending this slow 
process of disorganization, though these are more 
easily excited by slight causes than where there is 
no local disease. The constitutional disturbance 
will be found to be more proportioned to the de- 
rangement of the biliary secretion than to the 
change of structure or increase of bulk in the organ 
itself. Every practitioner must have seen instances 
where the liver descended low in the abdomen with 
little apparent inconvenience to the constitution, 
while, in other cases, where the same organ could 
scarcely be felt, the great deterioration of its func- 
tion has produced the utmost distress of mind and 
body, and led to dropsical effusions, fevers, and oth- 
er diseases destructive of life. From this it will 
be evident that one great object in the treatment of 
structural disease of the liver, is to correct or im- 
prove its function ^ and, as an inflammatory irrita- 
tion is at least a main cause both of the organic 
change that is going forward, and the disordered se- 
cretion that obtains, the removal of all agents that 
increase or keep up this irritation or inflammation, 
is a sine qua non in the treatment. As my object 
in this Essay is rather to render the indications sim- 
ple and clear, than to enter into minute details of 
therapeutical management, I need only observe 
that, in the organic disease of which we are treat- 
ing, our main chance of success lies in dietetic dis- 
cipline. If the patient will not consent to abandon 
the luxuries of the table and the stimulation of 
wine and all fermented liquors, his fate is cast, and 
bloated dropsy, with all its horrors, will soon over- 
take him. 

E 2 



49 ON THE DISEASES AND REGIMEN 

Rigid abstinence in respect to food, and a total 
abandonment of every kind of vinous and spiritu- 
ous potation, act in a triply beneficial manner. This 
system diminishes the supply of nutriment to the 
morbid growth ; withdaws stimulation from an al- 
ready irritated or inflamed organ ; and powerfully 
promotes the absorption of any interstitial deposit 
or other preternatural growth in the biliary appara- 
tus. The result is an improvement in the function 
of the organ, and a general amelioration of the 
health, if at all within the reach of amelioration. 

This is the fundamental principle of treatment in 
organic, as well as in functional disease. All the 
others are subordinate, but many of them very im- 
portant. There are medicines which experience 
has proved to be capable of increasing the power 
of the absorbents in the removal of morbid growths. 
The principal one is mercury ; but it must be very 
carefully managed in organic diseases. Mercurial 
frictions over the region of the liver should be pre- 
ceded by several repetitions of a smaller or greater 
number of leeches, according to the exigency of the 
case, and the strength of the patient After ten 
days or a fortnight, the leeches should be re-appli- 
ed ; then a crop of pustules brought out by tartariz- 
ed antimony ; and then again, the original mea- 
sures renewed. A succession of changes in this 
way, do a great deal more than a long continued 
course of any one remedial process.* In the mean 
time, the secretions should be strictly attended to. 
Gentle bitter aperients, as rhubarb combined with 
extract of chamomile or gentian, may be given, and 

*The propriety of a course of mercury, so as to affect the consti- 
tution, in tangible enlargements of the liver, must depend on the 
circumstances of the individual case ; for it would be very danger- 
ous to recommend it as a general rule, though nothing is more com- 
mon than the association, in the mind, of an enlarged liver and a 
course of mercury. It is known, however, that mercury is more 
beneficial in functional, than in structuial diseases of this organ. 



0? INVALIDS FROM HOT CLIMATES. 50 

even the sulphate of quinine, when the appetite and 
digestive powers are weak. These means will ena- 
ble the patient to take in and digest a sufficient 
quantity of light and unirritating nutriment to sus- 
tain the constitution, while attempts are made to 
reduce the unnatural structure in the liver. In 
organic as well as functional disease of the biliary- 
apparatus there is generally great derangement in 
the functions of the skin and the kidneys. Colchi- 
cum and Ine taraxacum are very useful auxiliaries in 
suchesoes, while the greatest attention is to be paid 
to dress, and to avoiding night air and moisture. 
The saline aperient waters of Cheltenham, with the 
combined advantage of country air and mental 
amusement, will much contribute to improve the 
function of the liver, and, through that process, the 
structure. Too little attention is paid to the urina- 
ry secretion in hepatic diseases, though it is of the 
utmost importance, for dropsical effusions are the 
consequences which are most to be dreaded in all 
organic affections of the biliary apparatus, and they 
generally become the ultimate cause of the fatal 
termination. The taraxacum, in the form of ex- 
pressed juice, or decoction of the root, with super- 
tartrate of potass and spices, is a very valuable me- 
dicine, as it improves the biliary secretion, and acts 
both on the bowels and kidneys. It may be used 
as a good substitute for mercury, or, at all events, 
to lessen the quantity that might otherwise be con- 
sidered necessary, of that active mineral. How far 
iodine may possess the power of reducing morbid 
growths in the liver, has not yet been ascertained ; 
but it seems worthy of trial. In India, the actual 
cautery is much used by the native doctors, in en- 
largements both of the liver and spleen, especially 
of the latter; and often with benefit Europeans 
do not like to submit to this apparently but not 
really formidable operation. The moxa might also 
be of some service. 



51 ON THE DISEASES AND REGINEN, &C. 

These very brief observations are all that I deem 
necessary to offer in respect to that organic disease 
of the liver which is ascertained by tangible en- 
largement. Without this criterion we have no 
positive proof of organic disease at all, and conse- 
quently our whole system of treatment hinges on 
regulating and improving the hepatic function — an 
indication which it is of infinite importance to pur- 
sue, and which would save many lives that are an- 
nually lost under the impression of organic disease, 
and under the system of treatment which is consid- 
ered suitable to such a condition of the biliary ap- 
paratus. I have endeavoured to reduce the diagno- 
sis within its proper, or at all events, its practical 
limits, and to restrain the vague notions respecting 
" liver disease," which are so prevalent and so de- 
trimental. Indeed, I am convinced that, were the 
term and the idea of " organic disease" of the liver 
obliterated, not only from the nosological chart, but 
from the minds of practitioners, it would be much 
better for their patients. No possible danger can 
accrue from mistaking an organic disease of the 
liver for a functional one ; but much mischief may 
result from the contrary mistake. 'This will appear 
a strange position to be maintained, and is the re- 
Verse of that commonly laid down ; but it is not 
stated without mature reflexion. More diseases of 
structure in the liver would be cured by careful at- 
tention to its function, than by all the other means 
put together. 

In quitting this subject, it is hardly necessary for 
me to say, that acute inflammation of this organ is 
passed over as not properly coming within the com- 
mon acceptation of structural or functional disease. 
It is to be treated like any other acute inflamma- 
tion, but with more attention to mercurial purga- 
tives. 



PART II. 

ON 

MORBID SENSIBXSXTir 

OF THE 

STOMACH AND DOWI^S. 



We now come to a class of complaints of most 
extensive bearing, and of paramount importance, 
not only to the valetudinarian, but to almost every 
individual in civilized life ; a class which so much 
disturbs our moral, as well as our physical nature, 
that it is hard to say which is the greater sufferer, 
the mind or the body ! This malady, or rather ab- 
stract of all maladies, is, in itself such a Proteus ; 
arises from so many different causes ; assumes so 
many different shapes ; produces so many strange 
and contrary effects, that it is almost as difficult to 
give it a name as to describe its ever-varying fea- 
tures. It knocks at the door of every gradation of 
society, from the cabinet minister, planning the rise 
and fall of empires, to the squalid inhabitant of St. 
Giles or Saffron Hill, whose exterior exhales the 
effluvia of filth, and interior those of inebriating 
potations. No moral attributes, no extent of power, 
no amount of wealth, are proofs against this wide- 
spreading evil. The philosopher, the divine, the 



53 ON MORBID SENSIBILITY OP 

general, the judge, the merchant, the miser, and the 
spendthrift, are all, and in no very unequal degree, 
a prey to the Proteian enemy. If this statement 
be correct; if, under such a variety of circumstan- 
ces, and excited by such a variety of causes, the 
same malady, or class of maladies, should be found 
to assail such different characters, and give rise to 
such an endless variety of phenomena, there must 
surely be some connecting link, some prevailing 
error, common to all, which can thus place the phi- 
losopher and the peasant, the affluent and the indi- 
gent, the virtuous and the vicious, on one common 
level in regard to a particular affliction of body and 
mind. The designations which have been applied 

to this disease are numerous. *nA «r»«- ™~ «** **----• 

.. } ~w»^ ...iwc ono yjt uiem 

expressive of the real nature of the malady, but 
only of some of its multiform symptoms. Of all 
these designations, indigestion has been the most 
hacknied title, and it is, in my opinion, the most 
erroneous. The very worst forms of the disease ; 
forms, in which the body is tortured for years, and 
the mind ultimately wrecked, often exhibit no sign 
or proof of indigestion ; the appetite being good, 
the digestion complete, and the alvine evacuations 
natural. Nearly the same objection lies against the 
term dyspepsia, or difficult digestion. The train 
of symptoms exhibited in indigestion or dyspepsia, 
is only one feature, (a very common one I grant,) 
of the Proteian malady under consideration ; and 
by no means the most distressing one. The term 
hypochondriasis conveys no just idea of the na- 
ture of the disease, though a group of some of its 
more prominent phenomena is usually understood 
by that term. Cullen was very wrong in defining 
hypochondriasis to be "indigestion, with languor, 
sadness, and fear, from uncertain causes, in a melan- 
cholic temperament." Many of the most exquisite 
specimens of hypochondriacism are unattended with 



THE STOMACH AND BOWELS. 54 

indigestion. Neither is Falret correct in making 
the brain the seat of hypochondriacism. The mind 
is affected, no doubt ; but only in a secondary man- 
ner. "Bilious disorder" is a term equally vague 
and equally erroneous as the others. Derangement 
of the biliary secretion is a frequent concomitant, 
perhaps a frequent cause or consequence of the ma- 
lady, but it is by no means always present, and 
when present, it is only one feature of the disease, 
and does not constitute its nature or essence. Of 
the various other designations, as spleen, vapours, 
melancholy, nervousness, irritability, mental des- 
pondency, &c. I need only say that they are forms 
or features of a disorder that assumes almost all 
forms. Hence my sagacious friend, Dr. Marshall 
Hall, not inaptly applied to this class the generic 
name mimoses, or imitators ; an appellation which 
is very significant, but which, of course, conveys no 
idea of the nature of the malady. It would, there- 
fore, be of great advantage to society at large, as 
well as to the profession, could we ascertain the 
leading causes by which this disorder is produced, 
the link by which its proteiform features are con- 
nected, and the means by which so complicated an 
affliction may be averted or removed. In order to 
clear the way for this investigation, the importance 
of which will be presently seen, it is necessary to 
make a few physiological and pathological observa- 
tions. 

In the nervous system we distinguish two great 
classes of nerves ; those which take their origin 
from the brain and spinal marrow; and those which 
are called the ganglionic nerves. The former trans- 
mit sensations to the sensorium, and nervous influ- 
ence to the voluntary muscles ; the latter regulate 
the functions of various vital and other organs, as 
those of the stomach, liver, heart, &c. It is in the 
first class of nerves that we find the common sensi- 



6S ON MORBID SENSIBILITY OF 

bility of touch, and also the nerves of the other 
senses, as sight, hearing, smelling, and tasting. 
These nerves of sense teach us at once, that particu- 
lar kinds of sensibility only are possessed by par- 
ticular nerves. The optic nerve is only sensible to 
light, and will not convey the sense of touch, hear- 
ing, tasting, or smelling :* — and, on the other hand, 
the auditory nerve receives no impression from 
light, or any thing but sound. The nerves distri- 
buted over the body for touch, will not convey any 
other impression than that which is peculiar to 
their office. Whenever the proper stimulus is 
applied to any of these nerves, we are conscious of 
the impression, at least while we are awake. Now 
the ganglionic nerves have their peculiar offices and 
stimuli, as well as the cerebro-spinal nerves ; but 
with this great difference, that we are quite uncon- 
scious of the impressions made on them, as long as 
the impression is within the range of salutary ac- 
tion. The stomach is as sensible to the stimulus of 
food as the retina is to light, but we feel nothing of 
the impression. Let any one attentively observe 
when he eats plain food, or swallows plain drink. 
He feels both of these in his mouth and palate ; but 
the moment that either of them passes down the 
oesophagus, he is quite unconscious of its presence 
in the stomach. It is so with all the internal or- 
gans. The lungs feel the air, but we are not con- 
scious of its presence in the air-cells ; the heart feels 

* The eye, for instance, in a state of health, may be touched by 
the finger, and hardly a sensation "will be excited ; but let the same 
organ be inflamed, and then the most painful sensation will he 
produced by the slightest touch. In the same way, the cartilagi- 
nons surfaces and the synovial membranes of the joints are endu- 
ed with a peculiar, and not a common sensibility. They feel not 
the friction produced by even violent motion ; but let inflammation 
take place in these parts, and then the peculiar or unconscious sen- 
sibility will be raised or changed into common or morbid sensibili- 
ty, and the slightest motion will be attended with exquisite pain. 



THE STOMACH AND BOWELS. 56 

the stimulus of blood, without our knowledge ; the 
gall-bladder is sensible to the presence of bile ; the 
intestines to chyle and to faeces; the urinary blad- 
der to urine, and so on ; while the intellectual sys- 
tem is quite unconscious of all these sensibilities. 

But let us go a step farther. Swallow a tea-spoon- 
ful of tincture of capsicum, or a wine-glassful of 
brandy, and then we feel not only a burning sensa- 
tion in the mouth and throat, but a certain degree 
of the same sensation in the stomach.* Simple as 
this experiment may appear, and unimportant any 
conclusion thence resulting, it nevertheless unfolds 
one of the most fundamental views in pathology, 

* We hear it commonly laid down by lecturers and others, that 
there is greater sensibility at the extremities of tubes and passages 
in the body, as the oesophagus, urethra, rectum, &c. than in the 
other portions of the same conduis. This is not a very clear view 
of the subject. There is more common or cutaneous sensibility at 
these extremities of passages, but less of the organic sensibility pe- 
culiar to these structures. When warm water is thrown up by a 
syringe into the rectum and colon, the heat is only felt in the an- 
us, unless the temperature be so high as to greatly offend the or- 
ganic sensibility of the mucous membrane, when a sense of pain 
rather than heat is felt in the bowels. It is the same with cold wa- 
ter injected into the intestines. It produces the sensation of cold 
in the rectum, but no sensation at all in the intestines, unless it be 
of very low temperature, when it occasions a dull colicky pain in 
the bowels. 

It is highly probable that different portions of the alimentary 
canal are endued with different kinds of sensibility. The sensibility 
of the stomach is in consonance with the presence of undigested 
food, which would occasion much inconvenience in the duodenum 
and other intestines ; while we know that the presence of bile in the 
duodenum produces no unpleasant effect there, whereas, if it re- 
gurgitate into the stomach, it disorders the whole system. The 
organic sensibility of the large intestines is very different in kind 
from that of the small. The presence of fajces in the colon and 
rectum produces no sensation ; but if matters pass down undigested 
from the stomach, the whole line of the intestines is irritated and 
annoyed ; although the effects are not felt there, but in various 
other parts of the body from sympathy. Onions, chesnuts, and a 
hundred other things, eaten in the evening, will disturb the organic 
sensibility of the stomach and bowels, producing what is called the 
fidgets, restlessness, incubes, and sundry other disagreeable sensa- 
tions, in parts of the body far remote from the actual seat of the 
irritation. 

F 



57 ON MORBID SENSIBILITY OF 

and one of the most useful precepts in the art of pre- 
serving health. The moment we call forth con- 
scious sensation in the stomach, whether that be of 
a pleasurable or a painful kind, we offer a violence to 
that organ, however slight may be the degree; 
Whenever the conscious sensibility of the stomach 
(or indeed of any other internal organ) is excited 
by any thing we introduce into it — by any thing 
generated in it; or by any influence exercised on 
it, through the medium of any other organ, we 
rouse one of Nature's sentinels, who gives us warn 
ing that her salutary laws are violated, or on the 
point of being violated,. Let us view the matter 
closer. We take an abstemious meal of plam food, 
without any stimulating drink. Is there any con- 
scious sensation produced thereby in the stomach? 
I say no. We feel a slight degree of pleasant sensa- 
tion throughout the whole frame, especially if we 
have fasted for some time previously, but no distinct 
sensation in the stomach. There is not — there 
ought not to be, any conscious sensibility excited 
in this organ by the presence of food or drink, in a 
state of health; so true is the observation that, to 
feel that we have a stomach at all is no good sign. 

The physiological action of food and drink on 
the stomach is shewn more on other organs and 
parts than in the stomach itself. When the quanti- 
ty is moderate and the quality simple, there is noth- 
ing more experienced than a general sense of refresh- 
ment ; aud the restitution of vigour, if some degree 
of exhaustion were previously induced. We are 
then fit for either mental or corporeal exertion. But 
let a full meal be made, and let some wine or other 
stimulating liquor be taken ; we still feel no distinct 
sensation in the stomach ; but we experience a de- 
gree of general excitement or exhilaration ; the cir- 
culation is quickened ; the face shews an increase of 
colour ; the countenance becomes more animated 



THE STOMACH AttD BOWEXS. 58 

be ideas more fluent. This excitement From food 
and drink, however, is not only transient, but it is 
moreover partial. In proportion as we have excit- 
ed the ganglionic system of nerves, or, in other 
words, the involuntary or vital organs, (stomach, 
heart, &e.) we disqualify the voluntary muscles for 
action, and the intellectual system for deep thought 
and other mental operations, In fact, we are then 
only fit to sit and talk very comfortably over our 
wine ; and ultimately to go to sleep. Whether 
this habit, which is that of civilized life in general^ 
be that which is best adapted for preserving or re- 
gaining health, is a question which I shall presently 
discuss; but, in the mean time, it will be sufficient- 
ly evident that pleasurable sensations are diffused 
over mind and body, by the presence of food and 
wine in the stomach, without the existence of any 
distinct sensation in the stomach itself. This is 
an obvious truth, and it is of great importance to re- 
member it. For if the nerves of the stomach, in a 
state of health, be capable of exciting pleasurable 
emotions in the mind, and comfortable sensations 
in the body, on the application of good food and 
generous wine, we shall find that the same nerves, 
when in a disordered state, are equally capable of 
exciting the most gloomy thoughts in the mind, 
and the most painful sensations in the body, on the 
application of the very same species of refection, 
either with or without an unpleasant sensation in 
the stomach itself. When the stomach is in a heal- 
thy condition, the application of certain agents will 
irritate its nerves, and produce a train of phenome- 
na bearing considerable analogy to those resulting 
from the application of common food in a disordered 
state of the gastric nerves. Thus, let some tartar 
emetic be secretly introduced with the wine which 
a man drinks after dinner. Instead of the pleasant 
sensations usually produced by this beverage, he 



59 ON MORBID SENSIBILITY OP 

soon begins to perceive a languor of mind and body; 
the face grows pale instead of red ; the mind is un- 
steady and depressed ; the muscular power is dimin- 
ished ; the head aches or becomes confused ; the 
heart beats slow or intermits — in short, there is a 
prostration of all the corporeal and intellectual pow- 
ers ; and all this, in many cases, before any disa- 
greeable sensation is felt in the stomach. At length, 
nausea and vomiting take place if the dose be con- 
siderable enough ; the contents of the stomach are 
rejected; re-action succeeds; and the mental and cor- 
poreal energy is once more restored. — If tincture, 
or any other preparation of digitalis be introduced 
into the stomach, a train of the most distressing 
symptoms is induced throughout the whole system. 
The head becomes giddy ; the sight imperfect; 
strange noises are heard in the ears ; dreadful de- 
pression of spirits is experienced, with a feeling or 
fear of dying; irregular action of the heart; sense 
of sinking at the pit of the stomach, &c. &c. These 
phenomena will often go to a great height, without 
any distinct or disagreeable sensation in the stom- 
ach. Sometimes, however, and especially if the 
deleterious agent be introduced abruptly and in 
large quantity, nausea and sickness of stomach are 
among the first phenomena, (though never the very 
first,) and then the other symptoms above enumer- 
ated follow. 

A thousand examples might be adduced where 
certain articles both of food and physic act in this 
manner on the nerves of the stomach, in the midst 
of health, and from thence diffuse their baleful influ- 
ence over mind and body. These examples are 
familiar to the medical practitioner, and there is 
scarcely an individual who has not experienced, in 
his own person, a sample, more or less impressive, 
of the above kind. 

These facts authorise us to conclude, first, that, 



THE STOMACH AND BOWELS. 60 

from the stomach, a diffusive energy and pleasurable 
feeling may be extended to all other parts of the 
body, and also to the mind, or at least to the organ 
of the mind, without any distinct pleasurable 
sensation in the stomach itself. Secondly, that 
from the stomach may be diffused over the whole 
system, intellectual and corporeal, a train of morbid 
feelings and phenomena of the most distressing 
kind, with or without any distinct sensation of 
pain or uneasiness in the organs of digestion. 

This view of the subject will be found of great 
importance in the investigation of diseases. It leads 
us to divide into two great classes, those sympto- 
matic or sympathetic affections of various organs in 
the body, dependent on a morbid condition of the 
stomach and bowels — viz. into that which is accom- 
panied by conscious sensation, irritation, pain, or 
disordered function of the organs of digestion ; and 
into that which is not accompanied by any sensible 
disorder of the said organs or their functions. Con- 
trary to the general opinion, I do maintain, from 
very long and attentive observation of phenomena, 
in others as well as in my own person, that this lat- 
ter class o£ human afflictions is infinitely more pre- 
valent, more distressing, and more obstinate, than 
the former. It is a class of disorders, the source, 
seat, and nature of which are, in nine cases out of 
ten, overlooked ; and for very obvious reasons, — 
because the morbid phenomena present themselves 
any where and every where, except in the spot 
where they have their origin. But it may be ask- 
ed, what are the proofs that various disorders, men- 
tal and corporeal, have their origin in gastric or in- 
testinal irritation, that irritation not being sensible 
to the individual? I answer, that the proofs will 
be found in the observation of cases every hour pre- 
senting themselves in practice. I ask for no assent 
to propositions or assertions, unless they accord 
F 2 



61 ON MORBID SENSIBILITY OP 

with the experience of the practitioner himself. 
There are great numbers of dyspeptics in the pro- 
fession as well as out of it. Let these observe, in 
their own persons, the phenomena which I shall 
point out as proofs of the positions I have laid down, 
and decide according to the evidence of their own 
senses. 

I have already shewn, in the examples of antimo- 
ny and digitalis, (and the list might be increased 
ad infinitum,) that the remotest parts of the system 
may be disordered through the medium of the 
stomach, before any sensible effect is produced on 
the stomach itself. This, however, is in a state of 
health. But let the nerves of the stomach and bow- 
els acquire a morbid sensibility or irritability from 
any of the various causes which I shall hereafter de- 
tail, and then it will require no such applications as 
antimony or digitalis to induce a host of affections 
in remote parts of the body. Such food and drink 
as, in health, would only nourish or agreeably stimu- 
late, will then act like a poison on the system, de- 
ranging the mental, and disordering the corporeal 
functions, often without the slightest sensible incon- 
venience in the stomach and bowels themselves. 
How is this ascertained ? By simple observation. 
Let a person labouring under any of those multi- 
form symptoms included in the terms dyspepsia, 
hypochondriasis, &c. and more especially under 
mental despondency, brought on, for example, by 
moral afflictions, but who feels no inconvenience 
in the stomach itself, take food and wine in rather 
too great a quantity, or of a certain quality, and 
the symptoms will be aggravated, not perhaps im- 
mediately upon ingestion, but after a short lapse of 
time, often without any of the phenomena of indi- 
gestion. Let the same person considerably reduce 
the quantity of even the mildest food, or abstain a 
whole day from any stongfood; and let him take 



THE STOMACH AND BOWELS. 62 

no wine or vegetable substance; — and he will find 
the symptoms mitigated. Let him return again to 
pretty full meals of mixed animal and vegetable diet, 
with his usual allowance of wine; again will the 
corporeal, and especially the mental disorder be 
exasperated. Let him adhere rigidly to a very ab- 
stemious proportion of the simplest and most unirri- 
tating species of food and drink, and take such med- 
icine as may be calculated to restore the natural, or 
obtund the morbid sensibility of the stomach and 
bowels; and then, if he does not experience, in a 
reasonable period of time, the most marked and sur- 
prising change for the better, I will grant that all 
my observations are mere creatures of the imagina- 
tion. I have seen so many instances proving in- 
contestibly the truth of these positions, that I am 
convinced, the great majority of those complaints 
which are considered purely mental, such as irrita- 
tability and irascibility of temper, gloomy melan- 
choly, timidity and irresolution, despondency, &c. 
might be speedily remedied and entirely removed 
by a rigid system of abstinence, and a very little 
medicine. On this account, medical men often have 
it in their power to confer an immense boon of hap- 
piness on many valuable members of society, whose 
lives are rendered wretched by morbid sensitive- 
ness of the mind, having its unsuspected source in 
morbid sensibility of the stomach and bowels. But 
more of this hereafter. 



ON 

MORBID SENSIBILITY 

OF THE 

STOMACH AND BOWKLS, 

ATTENDED WITH 

OBVIOUS DISORDER IN THE DIGESTIVE ORGANS.* 



I have stated that morbid sensibility of the gastric 
and intestinal nerves may be divided into two or- 
ders, viz. that in which there is sensible pain, ir- 



*h 



* It may appear an incongruity to consider the organic sensibili- 
of the stomach and bowels as morbidly increased at a time when 
e latter (the bowels) are generally supposed to be in a state of 
torpor, as evinced by constipation. But the organic sensibility of 
the bowels may be greatly perverted and exalted, and yet the mus- 
cular or peristaltic action irregular or even torpid. Besides, it is a 
law of the animal economy, that when nervous sensibility is too 
much excited in one part, it is too little so in some other. Thus, 
we often see the stomach and upper bowels in a state of great irri- 
tability, while the lower bowels are quite torpid, and will not pro- 
pel forward their^contents. Gastric irritability and vomiting are 
usually accompanied by constipation. Finally, I may observe, 
that the functions of the stomach, liver, and intestines, may be tor- 
pid, while the organic sensibility of their nerves may be in a state 
of morbid excitement. We see the functions of most organs 
suspended when they are in a state of inflammation, which must be 
a state of excitement of their nerves, and the same may be said of 
irritation. Very often, however, constipation is not an accompani- 
ment of morbid sensibility of the stomach and upper bowels. The 
large intestines are not unfrequently in a state of irritation as well 
as the small. 



THE STOMACH AND BOWELS. 64 

ritation, or other disorder in these organs, as well 
as various sympathetic affections, mental and cor- 
poreal, dependent on them ; and that in which the 
morbid sensibility of the digestive apparatus is, as 
it were, masked, and only shews itself in a variety 
of morbid feelings and conditions of other organs 
and parts, as well as in the intellectual functions. 
The first class or order has been much more accu- 
rately investigated than the second — and, therefore, 
I shall content myself with a very brief view of 
the prominent features of the first order. 



SYMPTOMS. 



The phenomena which supervene on the introduc- 
tion of too large a quantity of food into the sto- 
mach, or of some particular kind of food, which, 
from peculiarity of constitution, disagrees with the 
stomach, have been set down rather incautiously as 
symptoms of indigestion. Thus, a man in perfect 
health, and with an excellent appetite, is allured by 
variety of dishes, agreeable company, provocative 
liquors, and pressing invitations, to take in food 
more in accordance with the relish of appetite than 
the power of digestion. No inconvenience occurs 
for an hour or two ; but then the food appears to, 
and actually does, swell in the stomach, occasion- 
ing a sense of distention there, not quite so pleasant 
as the sensations attendant on the various changes 
of dishes, and bumpers of Burgundy. He unbut- 
tons his waistcoat, to give more room to the labour- 
ing organ ; but that affords only temporary relief. 
There is a struggle in the stomach between the vital 
and the chemical laws, and eructations of air and 
acid proclaim the victory of the latter. The nerves 



65 ON MORBID SENSIBILITY OP 

of the stomach are irritated by the new and injurious 
compounds or extrications, and the digestive power 
still farther weakened. The food, instead of being 
changed into bland and healthy chyme in a couple 
of hours, and thus passed into the duodenum, or 
second stomach, is retained for several hours in the 
stomach, occasioning a train of the most uneasy sen- 
sations, which I need not describe, but which amply 
punish the transgression of the laws of nature and 
temperance. Instead of sound sleep, the gourmand 
experiences perpetual restlessness through the 
night; or, if he sleeps, alarms his neighbours with 
the stifled groans of the night-mare. In the morn- 
ing we perceive some of those sympathetic effects 
on other parts of the system, which, at a later peri- 
od of the career of intemperance, play a more im- 
portant part in the drama. The head aches ; the 
intellect is not clear or energetic; the" nerves are 
unstrung; the tongue is furred ; there is more in- 
clination for drink than food ; the urinary secretion 
is turbid; and the bowels very frequently disorder- 
ed, in consequence of the irritating materials which 
have passed along the intestinal canal. This can 
hardly be called a fit of indigestion, though, even 
here, we find many of the leading phenomena which 
afterwards harrass the individual without such pro- 
vocation. It is a fit of intemperance, and repeti- 
tion seldom fails, in the end, to induce that morbid 
sensibility of the stomach and bowels which forms 
the characteristic feature of indigestion. 

I have called the above a fit of intemperance, 
and, of course, it is rather an extreme case, though 
by no means very uncommon. Nine-tenths of men 
in civilized society, however, commit more or less 
of this intemperance every day. If, when in health, 
we experience any degree of the foregoing symp- 
toms after our principal meal ; if we have a sense 
of distention, eructations, disturbed sleep, with sub- 



THE STOMACH AND BOWELS. 66 

sequent languor, there was intemperance in our re- 
past, if that repast did not amount to two ounces of 
food, or two glasses of wine. 

But established indigestion is not so much indu- 
ced by this violence habitually offered to the stom- 
ach, as by the reaction of other organs (whose func- 
tions have been disturbed sympathetically) on the 
organ of digestion, The nervous system and the 
liver repay with interest, after a time, the injuries 
they sustain from the stomach. The gastric fluid, 
so much under the influence of the nerves, becomes 
impaired; the hepatic secretion vitiated; and then 
the phenomena of indigestion gradually acquire a 
higher degree of intensity, by the additional sources 
of irritation, and the corresponding augmentation 
of morbid organic sensibility. 

This progressive march of the disorder has been 
artificially divided into stages, and considerable im- 
portance attached to the division. The marks by 
which the stages are supposed to be cognizable do 
not appear satisfactory to me, or accord with my 
own observations. Dr. Philip lays down a deviation 
from healthy appearance in the motions as marking 
" an important step in the progress of the malady." 
"It (the alvine discharge) sometimes contains," 
says Dr. Philip, "uncombined bile; sometimes it 
chiefly consists of bile ; its colour, at other times, is 
too light, more frequently too dark, at length al- 
most black; at different times it assumes various 
hues, sometimes inclining to green, sometimes to 
blue, and sometimes it is mixed with, and now and 
then wholly consists of, undigested bits of food." 
If these be marks of an important step in the pro- 
gress of indigestion, I can only say, that the above 
conditions of the biliary secretion may often be seen 
where there is no indigestion at all, and that they 
are very frequently absent, when there is the high- 
est degree of indigestion, or at least of dyspepsia. 



67 ON MOKBID SENSIBILITY OF 

That they mark a disturbance in the hepatic func- 
tion, there can be no doubt; but that they are ne- 
cessary attendants on any particular stage of indi- 
gestion, I cannot admit, consistently with my own 
observations. The functions of the liver, indeed, 
and the stomach are so intimately linked, that a de- 
rangement of one organ, and especially of the liver, 
is very commonly productive of derangement in 
the other, and it is difficult to say, in many cases, 
which has the priority. The appearance of the al- 
vine discharge is, unquestionably, one of the best 
indications of the state of the hepatic function, but I 
cannot admit that it is so good an index of that train 
of nervous and general dyspeptic symptoms as Dr. 
Philip seems to consider it. 

When this combination of gastric and hepatic dis- 
order obtains, whichever may have had the priority, 
the term " indigestion" is merely a conventional 
one, which is meant to designate a complication in 
which indigestion forms at most but a part, a very 
small part, and sometimes no part at all. I own 
that it is very hard for any one bnt a German to 
give such a name to this complication as may con- 
vey a clear idea of its nature. By the term " mor- 
bid sensibility of the stomach and bowels," I mean 
a disordered condition of the gastric and intestinal 
nerves, in which their natural sensibility is chang- 
ed, being morbidly acute, morbidly obtuse, (torpid) 
or perverted. By this term, I merely designate a 
fact or condition which, in my opinion, obtains 
much more generally in this class of maladies than 
the state called indigestion — indeed, I think I may 
aver, that it is never absent in the functional disor- 
ders of the digestive apparatus now under review, 
and that it forms the connecting link between these 
disorders and the various sympathetic affections of 
other and distant parts of the system. This is my 
apology for the term. 



THE STOMACH AND BOWELS. 68 

When the combination of liver and stomach af- 
fection is established, we have a train of well-mark- 
ed phenomena indicative of their co-existence. The 
appetite is fickle, being sometimes ravenous, at oth- 
ers almost annihilated, and sometimes whimsical. 
Whatever is eaten produces more or less of disten- 
tion, discomfort, or even of pain in the stomach, or 
in some portion of the alimentary canal, till the fae- 
cal remains have been evacuated. On this account, 
the bilious'and dyspeptic invalid is very anxious 
to take aperient medicine, as temporary relief is 
generally experienced by free evacuations. I say 
temporary relief; for purgation will not remove 
the cause of the disease, it only dislodges irritating 
secretions, soon to be replaced by others equally 
offensive. Indeed the usual routine of calomel at 
night and black draught in the morning, if too often 
repeated, will keep up rather than allay irritation in 
the bowels, and produce, as long as they are con- 
tinued, morbid secretions from the liver and whole 
intestinal canal. It is astonishing how long scybala 
and irritating undigested matter will lurk in the 
cells of the colon, notwithstanding daily purgation. 
Many instances have come to my knowledge, where 
portions of substances, eaten two, three, and four 
months previously, have at length come away in 
little round balls enveloped with layers of inspissat- 
ed secretions. These scybala keep up an irritation^ 
generally without any pain, in the bowels, and the 
effects of this irritation are manifested in distant 
parts by the most strange and anomalous sensations 
that appear to have no connexion with the original 
cause. The practitioner is thrown off his guard by 
the belief that, after repeated cathartics which scour 
the bowels, there cannot be any thing left there. 
But this is a great mistake. It is not the most 
energetic purgative that clears the bowels most ef- 
fectually. If irritation be first allayed by hyoseia- 
G 



69 OW MORBID SENSIBILITY OF 

mus or even opium, and then a mild cathartic ex- 
hibited, the evacuations will be much more copious 
than if the most drastic medicines were exhibited 
without previous preparation. 

In addition to the various appearances of the mo- 
tions, as described by Dr. Philip, I may add that, 
although the liver is often very torpid in this dis- 
ease, and conseqently the faeces of a clay-colour and 
devoid of natural smell, yet there is, in many cases, 
a copious secretion of viscid bile, which appears 
either distinct in the motions, or, when incorporat- 
ed with them, renders them as tenacious as bird- 
lime. It is exceedingly difficult to separate these 
motions from the bottom of the utensil by affusions 
of water. It is this tenacious ropy bile which hangs 
so long in the bowels of some people, and, by keep- 
ing up a constant irritation of the intestinal nerves, 
produces a host of uneasy sensations in various parts 
of the body, as well as fits of irritability in the mind. 
In some cases, where this poisonous secretion lurks 
long in the upper bowels, whose nerves are so nu- 
merous and sympathies so extensive, there is indu- 
ced a state of mental despondency and perturbation 
which it is impossible to describe, and which no 
one can form a just idea of, but he who has felt it 
in person. The term " blue devils" is not half 
expressive enough of this state; and, if my excel- 
lent friend, Dr. Marshall Hall, meant to describe 
itunder the head"mimosis inquieta," he never ex 
perienced it in propria persona ! This poison acts in 
different ways on different individuals. In some, 
whose nervous systems are not very susceptible, it 
produces a violent fit of what is called bilious colick, 
with excruciating pains and spasms in the stomach 
and bowels, generally with vomiting or purging, and 
often succeeded by a yellow suffusion in the eyes, 
or even on the skin. Severe as this paroxysm is, 
the patient may thank his stars that the poison 



TEE STOMACH AND BOWELS. 70 

vented its fury on the body instead of the mind. 
Where the intellectual faculties have been much 
harrassed, and the nervous system weakened, the 
morbid secretion acts in that direction, and little or 
no inconvenience is felt in the real seat of the ene- 
my. The mind becomes suddenly overcast, as it 
were, with a eloud ; some dreadful imaginary evil 
seems impending, or some real evil, of trifling im- 
portance in itself, is quickly magnified into a terri- 
fic form, attended apparently with a train of disas- 
trous consequences, from which the mental eye 
turns in dismay. The sufferer cannot keep in one 
position, but paces the room in agitation, giving 
vent to his fears in doleful soliloquies, or pouring 
forth his apprehensions in the ears of his friends. 
If he is from home, when this fit comes on, he has- 
tens back ; but soon sets out again, in the vain hope 
of running from his own wretched feelings. If he 
happen to labour under any chronic complaint at 
the time, it is immediately converted into an incu- 
rable disease, and the distresses of a ruined and 
orphaned family rush upon his mind and heighten 
his agonies. He feels his pulse, and finds it inter- 
mitting ; disease of the heart is threatened, and the 
doctor is summoned. If he ventures to go to bed, 
and falls into a slumber, he awakes in the midst of 
a frightful dream, and dares not again lay his head 
on the pillow. This state of misery may continue 
for 24, 36, or 46 hours ; when a discharge of viscid, 
acrid bile, in a motion of horrible fetor, dissolves at 
once the spell by which the strongest mind may be 
bowed down to the earth, for a time, through the 
agency of a poisonous secretion on the intestinal 
nerves 1 I believe such a train of symptoms seldom 
obtains except where there has been a predisposi- 
tion to morbid sensibility, occasioned by mental 
anxiety, vicissitudes of fortune, disappointments in 
business, failure of speculations, domestic afflictions, 



71 ON MORBID SENSIBILITY OP 

or some of those thonsand moral ills which render 
both mind and body so susceptible of disorder. It 
is under the influence of such paroxysms as these, I 
am thoroughly convinced, that nine-tenths of those 
melancholy instances of suicide, which shock the 
ears of the public, take place. Nothing is more 
common than to hear of these catastrophes, where 
no ostensible cause could be assigned for the dread- 
ful act. There might be no real moral cause ; but 
there was a real physical cause for the momentary 
hallucination of the judgment, in the irritation of 
the organ of the mind, through sympathy with the 
organs of digestion. Such is the intimacy of con- 
nexion, and reciprocity of dependence between the 
intellectual and corporeal functions ! 

The foregoing is a sketch of a high degree of bi- 
liary irritation acting on the mental faculties 
through the medium of the intestinal nerves. But 
there are a thousand shades of this irritation dis- 
playing themselves more in the temper or moral 
character, than in the corporeal functions. These 
I cannot at present stop to delineate. 

In the complicated disease under consideration, 
there are various functions disturbed, and phenome- 
na produced, which are all referrible to one com- 
mon source. The tongue is furred, especially in 
the middle and at the root, and, when there is much 
irritation in the stomach or duodenum, the papillae 
are elevated, and the edges and tip red. There is, 
in some people, a peculiar sense of constriction at 
the root of the tongue and about the fauces, which 
cannot be accounted for on any other principle than 
that of sympathy with the stomach. The mouth 
feels clammy, and there is a heavy odour on the 
breath. The clean red tongue, whether moist or 
dry, is indicative of serious mischief in the lining 
membrane of the stomach or bowels. It resembles 
a beef-steak, or cleanly dissected muscle. 



THE STOMACH AND BOWELS. 72 

The eye may or may not be tinged yellow ; but 
there is a peculiar muddiness or lack-lustre in the 
coats of that organ, with an expression of languor 
or irritability in the countenance, especially about 
noon, which are singularly characteristic of the 
malady, and indicate, with unerring certainty, its 
existence to the experienced physician. In people 
beyond the age of 45, there is usually a greater de- 
fect of vision, particularly by candle-light, when 
the digestive organs are disordered, that when the 
functions of the stomach and liver are in good con- 
dition. The urinary secretion is generally disturb- 
ed ; being either turbid, or high-coloured, with 
more or less of pink or white sediment. It is, for 
the most part, rather scanty than otherwise, with 
occasional irritation in passing it. Sometimes, 
when the individual is in a state of nervous irrita- 
tion, it is as limpid as pump-water, made every half- 
hour, and in large quantity in the aggregate. It is 
curious that this clear and tasteless water should be 
more irritating to the bladder than the most con- 
centrated and highly saline urine. The individual 
cannot retain more than a few spoonfuls at a time, 
without great inconvenience. 

The skin and its functions are very much affected 
in bilio-dyspeptic complaints. It is either dry and 
constricted, or partially perspirable, with feelings 
of alternate dullness and unpleasant heat, especially 
about the hands and feet. The skin, indeed, in 
these complaints, is remarkably altered from its na- 
tural condition; and the complexions of both males 
and females are so completely changed, that the pa- 
tients themselves are constantly reminded by their 
mirrors of the derangement in the digestive organs. 
The intimate sympathy between the external sur- 
face of the body and the stomach, liver, and alimen- 
tary canal, is now universally admitted, and ex- 
plains the reciprocal influence of the one on the 
G 2 



73 ON MORBID SENSIBILITY OP 

other. Many of the remote causes, indeed, of in- 
digestion and liver affection will be found to have 
made their way through the cutaneous surface. 

One of the most striking phenomena attendant 
on derangement of function in the liver and alimen- 
tary canal, is loss of flesh and of muscular power, 
The emaciation is easily accounted for, by the defi- 
cient supply of nutriment from an imperfect appa- 
ratus; and, it is not a little remarkable, that the 
liver-affection accelerates the loss of flesh much 
more than the stomach-complaint. The symptoms 
of dyspepsia may be very severe indeed, and yet 
emaciation will be very trifling; but let the function 
of the liver be much disturbed, and the flesh disap- 
pears with great rapidity. This is a strong proof 
that the bile is essential to the change of our food 
into healthy chyle. 

But the loss of strength, in this complaint, is out 
of all proportion to the waste of flesh. This is one of 
the most characteristic features of the disease, and 
is much more connected with nervous irritation in 
the stomach and bowels than with disorder of the 
liver. I have seen this prostration of strength in 
the highest degree where the biliary secretion was 
perfectly healthy, but where the nerves of the 
primae viae were extremely irritable. It is a sense 
of debility rather than actual debility. It is infi- 
nitely more distressing than real weakness. The 
least exertion, even that of stooping to take up a 
book, or stretching out the arm to take hold of any 
object, will cause such a feeling of inability for mus- 
cular action as quite depresses the spirits of the 
individual. Yet, perhaps, in less than three hours 
after this, when the food has passed from the sto- 
mach, or its remains from the bowels, the same in- 
dividual will be capable of walking a mile with 
comparatively little fatigue. This is a point which 
should be particularly inquired into, when ques- 



THE STOMACH AND BOWELS. 74 

tioning the patient; for the state above described 
is not one of actual debility, but of irritation. The 
patient may, it is true, be much weaker than when 
in health: but this debility is uniform, and propor- 
tioned to the decrease of muscular fibre ; whereas, 
the distressing sense of debility, now under consi- 
deration, is out of all proportion to the emaciation, 
is not uniformly the same, and is always greater 
when there is food in the stomach, or bad secretions 
in the bowels, than when both are empty. It is, in 
fact, a sympathetic debility, from nervous irritation 
in the alimentary canal. The distinction between 
these two kinds of debility is the more necessary, 
as the treatment is somewhat different. Bark, 
wine, rich food, and tonics, are not the remedies 
for debility arising from gastric and intestinal irri- 
tation. The wretched feeling from this source is 
exasperated rather than relieved by tonics and 
stimulants, unless very carefully employed in com- 
bination with soothing medicine, and diet of very 
easy digestion. 

In respect to a symptom on which much stress 
has been laid by Dr. Philip, as marking an impor- 
tant stage of indigestion, namely, tenderness at the 
epigastrium, on pressure, I have already made 
some observations. That it exists in every stage 
of. indigestion, I venture to affirm — and I will go 
one step farther, for I have no hesitation in averring 
that, if a whole regiment of soldiers were turned 
out and their epigastria pressed with the pointed 
fingers, and with the force which Dr. Philip uses, 
they would all wince, from the General downards. 
With the following observation of Dr. Philip, I 
most cordially agree: — "The patient, in general, is 
not aware of this tenderness till it is pointed out by 
the physician." As for its being any criterion of 
organic disease in the liver, I have already express- 
ed my conviction in the negative, and that it is 



75 ON MORBID SENSIBILITY OF 

characteristic of an inflammatory state, or incipient 
organic disease of the pyloric orifice of the stomach, 
I cannot, for several reasons, admit. One of these 
reasons is, that there is often much more tenderness 
in the epigastrium, in functional disorder, than in 
actual and unequivocal organic disease, as in scirr- 
hus of the pylorus, for example. Another reason 
is, that this tenderness in the epigastrium is fre- 
quently, if not generally, relieved by bitters and 
mild tonics, with light animal food, which would 
not be the case if it depended on inflammatory ac- 
tion or incipient change of structure. A third rea- 
son is, that the dyspeptic patient, in whom this ten- 
derness is so conspicuous, is proverbial for long 
life, and dies at last without any organic disease of 
the stomach. Let Dr. Philip himself bear wit- 
ness. " It is a curious fact," says he, " and one of 
the greatest importance in the treatment, that the 
organic affection rarely takes place in the origi- 
nal seat of the disease, but in other organs with 
which the stomach sympathises." This is a Pro- 
teian doctrine ; for it must ever elude the proofs af- 
forded by the scalpel. If the patient die of tuber- 
cles in the lungs, abscess in the brain, aneurism of 
the heart, enlargement of the liver and its conse- 
quences, or any other organic disease, dyspepsy 
having previously existed, we have only to say that 
the inflammatory action and change of structure 
began in the stomach, but shifted its seat, and ended 
in a distant part. " Thus," says Dr. Philip, " when 
the body is examined after death, the patient is 
said to have died of disease of some of these parts, 
and there is nothing in the appearance of the organs 
to distinguish such affections from disease which or- 
iginate in the organs themselves." It would be 
very easy to turn the arms of this doctrine against 
itself. Organic disease of the brain, for example, 
very frequently shews itself more, especially at an 



THE STOMACH AND BOWELS. 76 

early stage, in disordered function of the stomach, 
than in disordered function of the intellect, and, at 
such period, the patient would be said to labour 
under indigestion. But, as them alady advances, the 
functions of the brain and nervous system become 
unequivocally disturbed, and then it might be said 
the disease was extending itself sympathetically to 
the organ of the mind. At length, on death taking 
place, the brain would be found disorganized, and 
tho stomach sound; when Dr. Philip would ingeni- 
ously explain the matter by the above mode of rea- 
soning. Again, if sympathetic affections end so 
frequently as Dr. Philip imagines in organic disease, 
ho\¥ is it that, in fatal affections of the brain from 
chronic disorganization, where the functions of the 
stomach are proverbially deranged from sympathy 
with the sensorium, (all. sympathies being recipro- 
cal,) we so rarely find any organic change in the 
stomach ? Illustrations of this remark are innume- 
rable. I may only just allude to a remarkable in- 
stance published by Dr. Chambers, where a large 
tubercle growing in the brain shewed all, or almost 
all, its bad effects on the stomach for a great length 
of time, and yet, on dissection, the stomach was 
found healthy, and the seat of disease in the brain. 
In short, while I agree with Dr. Philip, that every 
part of the body sympathises readily with the sto- 
mach, whether in health or in disease, I do con- 
tend, from attentive observation and long experi- 
ence, that these sympathetic affections of distant 
parts end, comparatively speaking, but rarely in 
organic disease, and consequently, that Dr. Philip's 
doctrine is calculated to excite a great deal too 
much of alarm in the mind of the patient, as well 
as in that of the inexperienced practioner. As Dr. 
Philip contends for inflammation as the pathog- 
nomonic character of indigestion in its second stage, 
it was incumbent on him to shew all the proof of 



77 ON MORBID SENSIBILITY OP 

which the case is susceptible. He acknowledges 
that when the patient dies, it is of the organic dis- 
ease in a remote part, which was originally only 
sympathetic of the disease in the digestive appara- 
tus, the latter being no longer the seat of disease, 
and, consequently, exhibiting no alteration of struc- 
ture on dissection. So far, so good. But as indi- 
gestion, in all its stages, is one of the most common 
diseases which we meet, and as numbers of people are 
daily dying suddenly of other diseases or accidents, 
during the second stage of indigestion, why does 
not Dr. Philip bring forward proofs of inflamma- 
tion and insipient organic disease of the digestive 
apparatus, existing in that stage, as developed »by 
dissection ? This is the way in which we arrive at 
the knowledge of incipient changes of structure in 
other diseases not mortal in their early stages. But 
Dr. Philip offers us no such proof, and the conclu- 
sion is, that he could not. It will hardly be consi- 
dered an answer to this objection, that the pyloric 
orifice of the stomach is often found indurated in 
dram-drinkers. No one can deny that disease of 
the stomach may be brought on by such practices, 
but these cases have little analogy with the common 
dyspepsia so prevalent in civilized life, where in- 
temperance is on a very moderate scale. I have 
admitted more than some physicians will admit,* 
that sympathetic affection of the chest, from disor- 
der of the liver aud digestive organs, may and does 
end occasionally in organic disease. But we must 
recollect that disease of the lungs destroys nearly a 
fourth of the population, and that it is highly pro- 
bable that latent tubercles existed previously to the 
disorder of the stomach in almost all those who die 
of dyspeptic phthisis. The disease is, therefore, 

* See Dr. Paris, for example, who stoutly denies that there is, 
or can be, any such tiling as dyspeptic phthisis. 



THE STOMACH AND BOWELS. 75 

called into action rather than produced by the 
disorder of the digestive organs. Perhaps, the 
same observation may partly apply to the other or- 
ganic diseases sympathetically called forth. 

But to return to the subject of tenderness at the 
epigastrium. I contend, for the reason already sta- 
ted, and for many others which I could adduce, that 
it is owing to irritation rather than inflammation, 
in the great majority of cases, and, consequently, 
that it is no criterion of the latter disease in this 
class of complaints. The indiscriminate application 
of leeches for its removal, has, to my knowledge, 
very often aggravated the disease. The counter- 
irritation of a blister or tartar-emetic plaster is far 
more effectual, and harmonizes with the true nature 
of the tenderness- — morbid sensibility of the gastric 
and duodenal nerves. In my own person, and 
those of many others, I clearly ascertained this 
point, and found that tonics and bitters more effect- 
ually relieved this tenderness than leeches and blue 
pill. 

The same may be said of pain in the stomach, 
independent of pressure, of which, by the bye, Dr. 
Philip takes no notice, in the second stage of indi- 
gestion. This is a very common feature of the dis- 
ease; but affords no criterion of the existence of in- 
flammation. On the contrary, it is far more severe 
in functional disorder than in unequivocal inflam- 
mation of the stomach, and is relieved, as every one 
knows, by tonics and even stimulants, rather than 
by leeches or depletion. It is not a little remarka- 
ble, that Dr. P. should bring forward pain on strong 
pressure as indicative of inflammation, while he 
passes over severe pain, which is so very common- 
ly complained of, independent of pressure. But 
the fact is, that neither tenderness nor pain in the 
Btomach of a dyspeptic patient affords any proof of 
inflammation in that organ. 



79 ON MORBID SENSIBILITY OP 

Of fthe fulness at the epigastrium I have already 
spoken, and shewn that it is often more apparent 
than real, being produced by the emaciation so 
common in this class of complaints. That it is 
usually noticeable in indigestion I admit; but that 
it marks any particular period or stage of the dis- 
ease I never could discover. It is, I believe, much 
more frequently the effect of flatus than of organic 
disease. If the liver be enlarged, so as to cause 
this fulness, there will then be hardness of the 
part, as well as fulness, and the edge of the organ 
will be felt through the parietes. The cause will 
then be unequivocal. 

The observations which I have made, on tender- 
ness of the epigastrium will equally apply to what 
Dr. Phillip has advanced respecting a peculiar hard- 
ness of the pulse, as indicating a change in the na- 
ture of the disease from irritation to inflammation. 
The longer a practitioner lives, and the more he 
sees of disease, the more he will be convinced 
that the pulse is a " res fallaeissima" in indiges- 
tion as well as in other complaints. On this sub- 
ject, I must take the liberty of saying, that Dr. 
Philip appears to have refined to an excessive 
degree of minuteness. If a physician's whole 
sense was concentrated in the point of his fore-fin- 
ger, he would hardly be able to follow Dr. Philip in 
his diagnostic of hardness in a dyspeptic .pulse. 
This hardness is often to be recognized only by 
" a particular way" of feeling the pulse. "If the 
pressure be gradually lessened till it comes to noth- 
ing, it often happens that a distinct hardness of 
the pulse is felt before the pulse wholly vanishes 
under the finger, when no hardness can be felt in 
the usual way of feeling it." I appeal to the ex- 
perience of every practitioner, whether such a re- 
finement as the above can be entitled to much con- 
fidence in the examination of a phenomenon like 



THE STOMACH AND BOWELS. 80 

the pulse, which varies with almost every emotion 
or thought that crosses the mind of a dyspeptic 
invalid. Is it to be assented to, that, by such a 
criterion as this, we shall be enabled to distinguish 
irritation from inflammation ; or functional from 
organic disease ? The fact is, that, in irritation of 
the stomach or bowels, the pulse is often as hard and 
as quick as in inflammation of those parts.* The 
heart is so much under the influence of the stom- 
ach, in functional derangement of the latter organ, 
that no dependence can be placed on the state of 
the pulse, whether as regards hardness, frequency, 
or irregularity. In general, however, it will be 
found in dyspepsia, that the pulse is much quicker 
not only while the food is digesting in the stomach, 
but during the whole time that chyme is passing 
along the intestines, than after these processes are 
finished. The pulse through the day will often be 
up to nearly 80, and fall, by nine or ten o'clock at 
night, to 60. Indeed, the dyspeptic invalid is ne- 
ver so well as just before bed-time, when all irrita- 
tion is removed from the organs of digestion; and 
this often leads him to take (or supper such food 
and drink as render him miserable all the, next fore- 
noon. 

In fine, I am compelled to differ from Dr. Philip 
respecting tenderness of the epigastrium and hard- 
ness of the pulse, as pathognomonic signs of a par- 
ticular change in indigestion, from irritation to in- 
flammation; from functional to incipient organic 
disease. These symptoms are present in the earli- 
est as well as in the latest stages of indigestion ; 
nor do I believe that there is any regular order or 
succession of phenomena in this Proteian malady, 
by which the above-mentioned change can be as- 

* See Dr. Marshall Hall's excellent Essays on Intestinal Irrita- 
tion. See also the Memoir of M. Barras, on Gastralgia mistaken 
for Gastritis, in the Medico- Chirurgical Review for October, 1826. 

H 



81 ON MORBID SENSIBILITY OV 

certained. At the same time, I have no doubt that, 
even in the earliest periods of indigestion, there is 
occasionally inflammatory action mixed up with 
irritation, when excesses are committed, or impro- 
per stimulants have been exhibited. But, on the 
other hand, I am satisfied, from what I have person- 
ally experienced and seen in others, that all the 
phenomena of what is called the second st ge of 
indigestion, including tenderness at theepigas .rium 
and sharpness of the pulse, may and do very gen- 
erally depend on irritation ; or, in other words, on 
functional disorder of the stomach and bowels. No 
proof to the contrary has ever been given by the 
scalpel ; while the long lives and frequent recove- 
ries of dyspeptics, after years of suffering, afford 
strong presumptive proofs that no permanent in- 
flammation or organic disease had supervened on 
disordered function. This doctrine, while it is less 
disheartening than that of Dr. Philip, is equally 
prudent in point of practice. It lulls into no false 
security ; for if there be any one maxim in thera- 
peutics which is better established than others, it is 
that which teaches us to remove (if removable) as 
well as prevent disease of structure, by correcting 
disorder of function. If, in examining a case of in- 
digestion, we cannot determine whether or not in- 
flammation or organic change has commenced, (and 
I have shewn the difficulty, if not the impossibility 
of this discrimination by the marks which have 
been laid down by authors,) what can we do better 
than aim at improving the functions of the organs 
of digestion? Nay, we may go farther. Allowing 
that the tenderness in the epigastrium and hardness 
of the pulse did offer proof that inflammation or 
even organic change had commenced, I should be 
glad to know how we are to remedy the evil but by 
withdrawing the causes of all irritation from the 
organs themselves, which I shall shew is the funda- 



THE STOMACH AND BOWELS. 82 

mental indication in the treatment of mere func- 
tional disorder. 

Frebile symptoms, as evinced by alternate heats 
and chills, or by evening heat and dryness of skin, 
some degree of thirst, dryness of the tongue, defec- 
tive secretions, high-coloured urine, and more than 
usual colour in the face, with quickness of pulse, 
are certainly more characteristic of inflammatory 
action going on in some part of the system, than 
tenderness of the epigastrium; and, when conjoined 
with this last symptom, I have no objection to pro- 
per precautions, as leeching the epigastrium, and 
cooling saline aperients. But whoever has atten- 
tively watched or felt the phenomena of gastric 
and intestinal irritation, will acknowledge that even 
these, nay a very strong paroxysm of fever, may 
be produced by irritation alone, and where there is 
not a particle of inflammation present. This is eve- 
ry day seen in children, who will shew high fever 
and excitement, when irritating matters are lodged 
in the prirmB viae, and who will be cured of these 
symptoms in a few hours by a brisk cathartic. 
This faet should be %orne in mind, when the dys- 
peptic patient evinces febrile phenomena, and the 
means of removing irritation should always be em- 
ployed before we have recourse to those which are 
calculated for the reduction of inflammation.* 

* The younger Andral has recently published an interesting 
Memoir on Chronic Gastritis, in which he labours to shew, and 
with some success, that a peculiar disorganization of the mu- 
cous membrane of the stomach, which he terms ramollissement, or 
softening, is often found where no other symptoms had presented 
themselves, during life, than those which are common to the very 
lightest shades of indigestion. " There may have been," says he 
"no vomiting— no loss of appetite— no pain— no thirst— no dis- 
turbance of the circulation. The patient merely complains that 
the digestion is more or less uneasy and imperfect— and that he 
loses flesh and strength." 

This diseased condition of the mucous membrane shews itself 
in three grades or degrees. In the .first degree, the membrane- 



83 ON MORBID SENSIBILITY OF 

We are now to notice the more prominent sym- 
pathetic affections which depend on this combina- 
tion of gastric, hepatic, and intestinal disorder. It 
is difficult to say which is the organ or part that is 
most intimately linked in sympathy with the stom- 
ach and liver. I should say, however, that the 
brain, as the sensorium commune, to which all sen- 
sations are ultimately referred, is the first to sym- 
pathise with disorder of the abdominal viscera. 
Pain in some part of the head is a very common 
symptom in this class of disorders, but the func- 
tions of the brain are affected in a great variety of 
ways; especially its intellectual functions. Con- 
fusion of thought, unsteadiness of the mind, irrita- 
bility of the temper, defect of the memory, fickle- 

though softened and easily reduced to a pulp between the fingers, 
still preserves some degree of consistence before it is scraped off 
by the scalpel. In the second grade, we find only a layer of pulpy 
or gelatinous substance, of a white, grey, or reddish colour, which 
might be readily mistaken for a coat of mucus spread over the cel- 
lular membrane beneath. In the third degree, this semi-fluid pulp 
has disappeared, and the subjacent cellular tissue is left naked, in 
spaces of greater or lesser extent. 

M. Andral labours to prove that this softening is the legitimate 
product of chronic inflammation; but in this he is not quite satis- 
factory. He has, however, unequivocally proved that the above 
state of the mucous membrane takes place under the influence of 
irritating substances long applied to the stomach — in short, that it 
is intimately connected with a state of irritation, if not actual in- 
flammation. It is aggravated by the imprudent exhibition of 
stimulants and irritants — and it is soothed, or even cured, by an 
opposite system. M. Andral has described other morbid appear- 
ances in the stomachs of dyspeptics, as discolorations, morbid 
thickenings of the coats of the organ, &c. which shew that indi- 
gestion, though seldom fatal, may, if improperly treated by tonics 
and stimulants, end in disorganization of the coats of the stomach. 

Speaking of the nerves of the stomach, M. Andral remarks : — 
" Neither can we doubt that, among the various disturbances of 
function which the stomach undergoes, there are many which 
imitate, more or less completely, acute and chronic gastritis, but 
which are, in reality, owing to a morbid state of the gastric nerves 
or the centres of the ganglionic system. Hence, in some individu~ 
als, we have disordered digestion ; in others vomitings ; and in 
others still, epigastric tenderness and pain," &c. &c. &c. — In thia 
I entirely agree with M. Andral. 



THE STOMACH AHD BOWELS. 84 

ness of disposition, and many other phenomena 
which are little suspected of corporeal origin, shew 
themselves infinitely more often than pain, deaf- 
ness, vertigo, defect of vision, or affections of mere 
sensation. The former gradually rise into gusts of 
passion, fits of despondency, brooding melancholy, 
permanent irascibility, and still higher grades of 
intellectual disturbance, till, as sometimes happens, 
the point of temporary alienation is reaehed, and 
suicide terminates the scene. Those functional dis- 
turbances of the brain, however, which are evinced 
in the form of mental phenomena, are very com- 
mon in morbid sensibility of the gastric and intes- 
tinal nerves, where the usual symptoms of indiges- 
tion and hepatic derangement are almost entirely 
wanting. In unequivocal disorder of the digestive 
organs, the affections of sensation about the head 
most engage the patient's attention. Pains of vari- 
ous kinds, not seldom remittent or intermittent, are 
felt in different parts of the scalp, about the face, or 
deep in the head. When purely sympathetic of 
stomach disorder, they are more frequently in some 
particular part, than in the head generally, and as- 
similate in their nature to tic douloureux. Indeed, 
I have no doubt that this dreadful disease is, in nine 
cases out often, caused by irritation of the ganglio- 
nic nerves; and the cures which have been per- 
formed by alterative and aperient medicines, and 
especially by the carbonate ofirdn, (which removes 
the morbid sensibility of the nerves,) confirm this 
opinion. 

In conformity with these views, it is fairly to be 
persumed, that many eases of epilepsy, are to be re- 
ferred to morbid sensibility and irritation of the 
gastric and intestinal nerves, else how should pur- 
gation and lunar caustic cure the complaint ? The 
former removes the sources of irritation, and the 

H 2 



85 ON MOBBID SENSIBILITY OP 

latter the morbid nervous sensibility. But more 
of this anon. 

If sympathetic disorder of the brain or its mem- 
branes be long continued, it is believed, and it can- 
not be positively denied, that inflammation first, 
and change of structure afterwards, will be the re- 
sult. When these processes are once set up, they 
become, of course, in a great measure indepen- 
dent of the original cause that produced the sympa- 
thetic disorder, whether of function or sensation; 
and they are then not to be distinguished from 
idiopathic disease of the same parts. Nor would 
the discrimination, if practicable; be of any use, as 
respects the treatment. In what proportion of ca- 
ses these sympathetic affections of the head change 
into inflammatory and organic diseases, it is impos- 
sible to say, since few cases indeed have been so ac- 
curately watched through all their stages as to afford 
any satisfactory proof, if the thing is at all suscepti- 
ble of proof, which is very doubtful. As far as my 
own observation extends, this conversion into or- 
ganic disease is not so frequent as is imagined. 
Head-aches of great intensity, and even epilepsy 
go on for years, and leave no traces of their exist- 
ence, when death happens from other diseases. On 
the other hand, we see organic changes of immense 
extent take place in the brain, with but little pain 
or disturbance of the intellectual functions, even 
till the last. These facts should teach us caution 
in pronouncing on such a difEcult subject, and dis- 
trust of all theories or preconceived opinions. 

None of the senses are more frequently affected 
sympathetically than those of hearing and sight, 
Noise in the ears, and partial deafness are very 
common where the function of digestion is disor- 
dered, and may often lead us to suspect the latter, 
when very few of the common symptoms of indi- 
gestion are present. It is not uncommon for deaf- 



THE STOMACH AND BOWELS. 8(5 

ness, noise in the ears, and sense of confusion in 
the head to disappear, for a time, after tea, coffee, 
dinner, or a glass or two of wine, and again to return 
when the stomach is empty. When this is the 
case, we may be assured that the cause is in the 
stomach, and that the affections of the head and or- 
gan of hearing are purely symptomatic. When 
these symptoms are aggravated by eating or drink- 
ing, there is then some reason to dread that a more 
permanent state of disorder, if not actual disease, 
is establishing itself in the head, and remedies should 
be directed to that quarter without delay. The 
same observations apply to affections of the organ 
of vision, as muscae volitantes, indistinctness of 
sight, uneasiness in the eyes when reading, or when 
exposed to a glaring light. These phenomena 
should not be treated too lightly. They may be 
precursors, or rather indications of a complaint 
more formidable than that in the stomach from 
whence they originally sprung. 

Next to the brain, I would say that the heart and 
mucous membrane of the lungs sympathise most 
readily with disorder of the liver and digestive ap- 
paratus. The irrregularity of action in the heart, 
consequent on disorder of the liver and stomach, is 
much more common than is generally suspected, 
being often passed unnoticed by either patient or 
practitioner. The intermission of the pulse, and 
the sense of tumult in the region of the heart are 
sometimes very alarming to the hypochondriac or 
dyspeptic invalid, and also to the young practi- 
tioner; but they are really of little importance.* 

* In a very few instances, I have seen most of those symptoms 
which appertain to real angina pectoris, produced by disordered 
function of the stomach, and give way to a radical change of 
regimen and diet. But in general it is in the form of palpitation, 
and intermissions of the ventricular action, that the sympathetic 
disorder of the heart shews itself, and is then not very distressing, 
unless the patient's mind be alarmed by the irregularity of the 



87 ON MORBID SENSIBILITY OP 

That diseased structure of the heart does occasion- 
ally result from long-continued disturbance of its 
function, occasioned by bilio-gastric affection, I 
know is the case ; but the instances are so compara- 
tively rare, that this very circumstance affords 
ground for the belief that the same may be said of 
other sympathetic affections. I am acquainted at 
this time with one case where the action of the 
heart has been greatly disturbed for more than ten 
years, by dyspepsia, and yet when attention is paid 
to diet and the state of the bowels, the action of the 
heart becomes perfectly regular. Disease of the 
liver, however, is much more apt seriously to en- 
danger the heart than mere dyspepsia. In propor- 
tion, therefore, as the hepatic affection predominates 
over the gastric, so will be the risk of sympathetic 
disorder of the heart changing into disease of its 
structure. In all dyspeptic cases, therefore, the 
practitioner should bear this in mind, and be gui- 
ded in his prognosis accordingly. But he should 
also not fail to examine the heart by means of aus- 
cultation, which will afford him the most certain 
means of diagnosis between functional and structu- 
ral disease of this organ. 

Of the sympathetic affection of the lungs ending 
occasionally in phthisis, I have already spoken. I 
think Dr. Paris has been thrown off his guard in 
treating what is called "dyspeptic phthisis" as a 
creature of the imagination. Nothing is more 
common than a cough from irritation of the sto- 
mach, and it is surely unsafe to aver, that long-con- 
tinued disorder of function can never end in disor- 
ganization. But, however this may be, it is no 
longer a matter of doubt that chronic inflammation 
and other organic disease of the liver does very fre- 

pulse. In most cases of disordered digestion there is an irritability 
of the heart, which causes it to be excited into quick action by very 
trifling agitations of mind or exertions of body. 



THE STOMACH AND BOWELS. 88 

quently affect the contiguous lung, which becomes 
hepatized, and, if there be any tubercular disposi- 
tion in the respiratory apparatus, phthisis is sooner 
or later developed. This is more particularly the 
case on the return of an invalid from a hot to a cold 
climate with hepatitis. But on this subject I need 
not add to what I have formerly adduced. 

Of the sympathies between the digestive appara- 
tus and various other parts of the body, as the kid- 
neys, bladder, urethra, rectum, organs of sense, 
skin,&c. it would be difficult to give a description. 
The urinary secretion is particularly under the in- 
fluence of biliary and gastric disorder, and, I believe, 
nine-tenths of those who are affected with the grav- 
el and calculous complaints would get cured (unless 
the stone was of some size) by a particular regimen, 
which will be presently described. The sympa- 
thies established between the cutaneous nerves and 
those of the digestive organs are very numerous, 
and tend to puzzle the practitioner exceedingly^ 
The shoulders, the back, the limbs, the face, are 
all very subject to painful and indescribable sensa- 
tions from irritation in the primae viae, and the ner- 
vous connexions do not afford satisfactory expla- 
nation of these phenomena, since the sympathetic 
association is generally strongest where the nervous 
communications are least numerous. Whenever 
these unaccountable feelings are complained of, 
they should lead us to suspect chylopoietic irrita- 
tion, and this irritation will often be found to exist, 
and to be the cause of the phenomena when there 
are very few of the common symptoms of indiges- 
tion or of derangement of the biliary secretion pre- 
sent. This brings us to the second division of this 
curious subject, 



ON 

MORBID SEH SIBIMTlf 

OF THE 

STosvyuya &xd howi^s, 

WITHOUT ANV OBVIOUS OR WELL MARKED SYMPTOM 
OP DISORDER IN THOSE ORGANS THEMSELVES. 



This is a subject which has been little treated of by 
writers on this class of diseases, and yet it is one of 
very great importance. It is necessary, in the out- 
set, to take a short review of the causes of morbid 
sensibility in the stomach and bowels, whether ac- 
companied or not by the ordinary symptoms of 
disorder in the organs of digestion. These may be 
divided into two classes; physical and moral. Nu- 
merous and powerful as are those of the first class, 
the moral causes are still more predominant and 
effective. 

PHYSICAL CAUSES. 



These are very numerous, the surface of applica- 
tion being that of the whole body, external and in- 
ternal. The stomach may be considered, not even 
excepting the brain, as the greatest centre of sympa- 



THE STOMACH AND BOWELS. 90 

thies. Every impression on the skin, whether of 
cold or of heat, of humidity or of drought, influen- 
ces, more or less, the functions of the stomach. 
This must have been experienced by every indi- 
vidual. In a climate like ours, therefore, where 
atmospheric changes areso perpetually occurring, 
not only as to temperature, but as to humidity, den- 
sity, rarity, &c. we need not wonder that the func- 
tions of the alimentary canal should be so frequent- 
ly disturbed. 

Among those who live in the pure and open air 
of the country, these atmospheric changes have 
comparatively little effect ; but in cities and large 
towns, where the whole constitution is effeminated; 
where the external surface of the body is not ha- 
bituated to the vicissitudes of the skies ; where 
moral causes are constantly operating injuriously 
on the digestive organs; and where air, imbued 
with millions of miasmata, exhaled from every 
thing in the animal, vegetable, and mineral king- 
doms, is breathed, swallowed, and kept in contact 
with the skin, the effects are conspicuous, in the sal- 
low complexions, puny or capricious appetites, 
and imperfect digestion of the inhabitants. 

This state of the appetite and digestion, resulting 
from sedentary habits, impure air, late hours, and 
mental perturbations, leads to an aggravation of the 
evil, by the recourse which is had to high-seasoned 
dishes and stimulating drink, indulged in, more or 
less, by all classes of society. The nerves of the 
tomach are daily irritated by what is ingested ; 
while the nerves of the bowels are irritated by what 
is undigested. To these causes may be added the 
-itiated secretions themselves, not only of the sto- 
mach, but of the liver, pancreas, and all the innum- 
rable glands that stud the surface of the alimentary 
canal. These circumstances produce all the phe- 
nomena of indigestion detailed in the preceding 



91 ON MORBID SENSIBILITY OF 

section, not only as regards the disorder in the or- 
gans of digestion themselves, but as respects the 
innumerable affections of distant parts, from sympa- 
thy with the stomach, and other internal viscera. 

The qualities and quantities of food and drink, 
which produce or keep up irritation and morbid 
sensibility in the digestive organs, are but little sus- 
pected of mischief, because they are in general use, 
and because many individuals are daily seen to take 
far greater liberties with the luxuries of the table, 
without any very apparent bad effects resulting. 
The evil day, however, arrives at last, and it is 
found that the same food and drink which had been 
so long taken with impunity, now begin to be fol- 
lowed by uncomfortable sensations, and, at length, 
with actual disorder in the digestive apparatus. 
Still this is considered as an accidental occurrence, 
not connected with previous habits of diet, but ow- 
ing to other and unknown causes. This last is 
very often true, in part. The previous habits may 
only have produced a predisposition to indigestion ; 
and, then, when any other cause is applied, especi- 
ally of a moral nature, the explosion takes place. 
The fact appears to me that, in civilized life, the 
host of and moral physical causes of disease that are 
always in operation keep the powers of the digestive 
organs below the standard of health ; while the 
quantity and quality of our usual food and drink 
are calculated to impair these same organs, even if 
they were in a state of the most perfect integrity of 
function. If this position be true, and I believe it 
to be so, it is easy to see the reason why so many 
labour under indigestion, even in its obvious or 
open forms. Among the leading physical causes 
of indigestion, then, I place our daily food and 
drink. I have shewn that neither the one nor the 
other ought to produce any sensation in the stom- 
ach, if taken in the proper quantity, and of the 



THE STOMACH AND BOWELS. 92 

proper quality. But, whenever our drink induces 
sensible excitement in the system, or our food is 
followed by an inaptitude for mental or corporeal 
exertion, we have transgressed the rules of health, 
and are laying the foundation for disease. When 
food produces any sensation of discomfort in the 
stomach, as sense of distention, &c. attended or not 
with some degree of depression of spirits or irrita- 
bility of temper, indigestion, (or rather morbid sen- 
sibility,) has actually commenced ; and the height 
to which it may be carried, if the irritation of food 
and drink be continued. I need not now describe. 

As, of all the physical causes of indigestion, our 
diet is the chief; so over this cause we fortunately 
have the greatest control. But sensuality and con- 
viviality are perpetually seducing us from the paths 
of temperance, and seldom permit us to think of 
preserving health till we have lost it. It is quite 
needless to describe the kinds and quantities of food 
and drink that are injurious. I have shewn the 
rule by which each individual is to judge of this 
matter : — any discomfort of body, any irritabili- 
ty or despondency of mind, succeeding food and 
drink, at the distance of an hour, a day, or even 
two or three days, may be regarded (other evi- 
dent causes being absent) as a presu?nptive proof 
that the quantity has been too much, or the qua- 
lity injurious. 

It is, however, far more frequently by the quan- 
tity of our food that the stomach is irritated and its 
nerves rendered morbidly sensible, than by the 
quality. In respect to this last, the vegetable 
world (however lauded by hermits and philoso- 
phers) is infinitely more prolific of irritation, and 
its consequence, morbid sensibility, than the animal 
kingdom. Farinaceous food, however, as gruel, 
for example, is an exception. Perhaps, of all spe- 

I 



93 ON MORBID SENSIBILITY OF 

eies of food, this is the least irritating, and where a 
high degree of morbid sensibility prevails, it is of- 
ten the only thing that can be borne. Tender ani- 
mal food is next, in point of unirritating qualities, 
with the advantage of being more nutritious and 
less bulky. We see whole nations, as the Hindoos 
and Scotch, live and thrive on food almost exclu- 
sively farinaceous ; while others, as in some parts 
of South America, live well upon animal food, and 
that almost alone. 

In respect to drink, water is the only fluid which 
does not possess irritating, or at least, stimulating 
qualities ; and in proportion as we rise on the scale 
of potation, from table beer to ardent spirits, in the 
same ratio we educate the stomach and bowels for 
that state of morbid sensibility, which, in civilized 
life, will sooner or later supervene. 

The physical causes, then, of morbid sensibility 
of the nerves of the digestive organs are, atmos- 
pheric impressions on the external surface of the 
body ; cutaneous disorders and their sudden retro- 
pulsion ; disordered functions and diseased struc- 
tures in other parts of the body, as in the brain, li- 
ver, &c. acting through the medium of sympathy 
on the organs of digestion ; food and drink in too 
large a quantity, or of too stimulating or indigesti- 
ble a quality, acrid substances, as drastic purga- 
tives, &c. taken into the stomach, or generated in 
the alimentary apparatus. Under these heads all, 
or almost all, the physical causes may be ranged. 
They are very numerous, and act through two prin- 
cipal channels ; sympathy and direct application. 

If it be asked how food, which is the natural 
stimulus of the nerves of the stomach and bowels, 
should render them morbidly sensible? I might 
answer, by asking another question ; how does 
light, which is the natural stimulus of the optic 
nerve, render it morbidly sensible, if too brilliant 



THE STOMACH AND BOWELS. 94 

and too long applied ? The parallel, I think, is per- 
fectly just. 

The same reasoning is applicable to drink. If 
for water we substitute beer, wine, or spirits, we 
stimulate the nerves of the stomach, though some 
stomachs will bear this stimulation for many years, 
in succession, with little apparent injury. But not 
so in civilized life. By this stimulus the nerves 
are excited, and, in due time, irritated, so as to set 
up an habitual state of morbid sensibility. The 
doctrine of Brown, indeed, teaches us that this con- 
stant stimulation will ultimately wear out the exci- 
tability of the nerves, and render them less sensi- 
ble than at first, to the same stimuli. It may be so ; 
but I much doubt whether, in the last sad years of 
the confirmed drunkard, the morbid sensibility of 
the stomach and howels is not still his unhappy lot. 
His appetite and powers of digestion are nearly ex- 
tinguished, I grant; but the stomaeh becomes more 
irritable, in proportion as intemperance has been 
long-continued ; till, at length, the presence of food 
cannot be borne without pain or sickness, and a 
very small quantity of that burning potation which 
he used to swallow so freely, now makes him quick- 
ly inebriated. These are facts which we see every 
day, and they strongly support the position I have 
laid down. 



MORAL CAUSES. 



There is but one path along whieh these causes 
can travel from the organ of thought to the organs 
of digestion : but the number of airy sprites, and 
the velocity with which they glide along the silve- 



95 ON MORBID SENSIBILITT OF 

ry pneumo-gastric conductors, baffle alt calculation f 
The intellectual operations of man, in a state of 
high civilization, as compared with man in a state 
of nature, are as much more numerous as the me- 
chanical arts of Europe out-number the simple con- 
trivances of Otaheite. In such proportion, also, 
his susceptibility to moral impressions is augment- 
ed to an incalculable extent; and these impressions, 
though first received by the sensorium, are all re- 
flected on the organs of digestion, with more or less 
force, according to the state of predisposition ia 
these organs. In this country, where man's rela- 
tions with the world around him are multiplied be- 
yond all example in any other country, in conse- 
quence of the intensity of interest attached to poll- 
tics, religion, commerce, literature, and the > arts; 
where the temporal concerns of an immense pro- 
portion of the population are in a state of perpetual 
vacillation ; where spiritual affairs excite great 
anxiety in the minds of many; and where specu- 
lative risks are daily run by all classes, from the 
disposers of empires in Leadenhail Street, down to 
the potatoe-merchant of Co vent Garden, it is really 
astonishing to observe the deleterious influence of 
these mental perturbations on the functions of the 
digestive organs. The operation of physical caus* 
es, numerous as these are, dwindles into complete 
insignificance, when compared with that of anxiety 
or tribulation of mind. These causes very often 
escape the investigation of the physician, unless ho 
is very much on his guard. The patient is prodi- 
gal of description, as far as regards his corporeal 
feelings ; and he is often very candid as to the 
physical causes which may be enquired after by the 
practitioner ; but he seldom reveals (for obvious 
reasons) the real origin of the evil, when it is of a 
moral nature, unless it be dexterously drawn from 
him by artful cross-questioning. The disorder of 



TfiE STOMACH AWD BOWELS. 96 

the digestive apparatus, however, induced through 
mental emotions, is very generally of a different cast 
from that resulting from physical causes, such as in- 
temperance, &c but the slightest physical causes, 
in addition, exasperate the complaint exceedingly. 

It is hardly worth while to attempt any physio- 
logical explanation of the mode in which the men- 
tal discomfort effects the corporeal disorder. The 
fact has not escaped the notice of even the most 
heedless observer, and is pointedly alluded to by 
poets as well as physicians. A single look, and a 
very few words from the tyrant monarch, gave the 
ambitious Wolsey a fit of indigestion, which termi- 
nated the Cardinal's life! The function of digestion, 
as indeed every function, is so completely under 
the nervous influence, that there can be no doubt 
of the channel through which the mischief is pro- 
duced. MentaV anxiety not only arrests or disturbs 
the digestive process in the stomach, by interrupt- 
ing or weakening the nervous influence on which 
it depends, and thereby leaving the materials of 
food open to the chemieal laws that would act on 
them out of the body ; but, in a remarkable man- 
ner, vitiates or impairs the biliary secretion, there- 
by adding a new and powerful source of irritation 
to the delicate nerves of the duodenum and small 
intestines. The consequence is, that the whole 
line of the alimentar}'- canal, from the cardie orifice 
to the valve of the colon, is kept in a state of irri- 
tation, from the time the food is taken in, till its 
remains pass into the great intestine. This is dis- 
tinctly felt by the individual, who has no ease 
either in mind or body, till the process of digestion, 
such as it is, and of chylifieation is over, when he 
feels comparative comfort. The mind and body 
then seem relieved from a burthen, and a most sig- 
nificant remark is often made hy people in this con- 

I 2 



97 ON MORBID SENSIBILITY OF 

dition, that, if they could live without food they 
would be well. Whenever this observation is 
made, we may rest assured that there is a morbid 
sensibility established in the nerves of the alimen- 
tary canal ; and it is two to one that this has been 
induced by mental anxiety, or, in other words, by 
moral causes. But, m a great proportion of cases, 
the effects of this morbid sensibility of the stomach 
and bowels are not distinctly recognized by the in- 
dividual by pain or uneasiness in the parts them- 
selves, nor by any very morbid state of the evacua- 
tions, but in the re-action of the gastric and intesti- 
nal irritation on the mental faculties. They notice, 
therefore, the exasperation of these mental mise- 
ries, at certain times, but do not suspect the food 
and drink as the cause of these exasperations. 
Hence arises a whole class of maladies, which, as 
being unattended by any evident disorder of the 
body, are attributed to the imagination, and the un- 
happy individual is put down by his friends, and 
too often by his physician, as adecided Hypochon- 
driac. 



HYPOCHONDRIASIS. 



This curse of civilization is not confined to any age 
or any nation. Wherever the mind has been cultiva- 
ted at the expense of the body, there hypochondria- 
cism has prevailed. Aristotle informs us that all the 
great men of his time were hypochondriacs, and 
the disease, in its more marked forms, has been des- 
cribed by physicians and even poets, from Hippo- 
crates down to the present time. 

In respect to the nature of this disease, I am con- 
vinced that juster notions were entertained of it 
some hundreds of years back than at the present 






THE STOMACH AND BOWELS. 98 



moment, with all the advantage of pathological in- 
vestigations. Cullen defines it to be " indigestion, 
with languor, sadness, and fear, from uncertaiu cau- 
ses." Now, 1 do maintain that, although hypo- 
chondriacal symptoms often attend indigestion, as in 
deed I have abundantly shewn, yet, indigestion is 
by no means essential to hypochondriasis. In two 
patients whom I am now attending, and who are 
perfect models of hypochondriacism,the appetite is 
good, the evacuations perfectly natural, and no 
pain, flatulence, or other symptom of indigestion in 
the stomach, is complained of. In both these in- 
stances, however, the hypochondriasis may, at plea- 
sure, be exasperated or mitigated by free or by ab- 
stemious living — shewing that the nerves of the 
stomach and bowels are concerned in the mental 
phenomena. The Cullenian doctrine, I believe, is 
the prevailing one in this country; while two dif- 
ferent theories of the disease obtain on the Conti- 
nent, especially in France. The disciples of Brous- 
sais consider hypochondriasis as depending mainly 
on a state of chronic gastro-enteritis, while an able 
author, M. Falret, has laboured to prove that the 
seat of the disease is in the brain. The doctrine 
of Broussais is, indeed, pretty nearly the same as 
that of Dr. Philip ; but it is surely untenable, see- 
ing the lengthened age which hypochondriacs at- 
tain, and the frequent absence of all symptoms or 
proofs of gastro-enteritis. In respect to M. Fal- 
ret's doctrine, I think it is evident that the affection 
of the brain is more often secondary than primary, 
though it is very reasonable to believe that, in pro- 
cess of time, the brain does actually become affected, 
in the same way as we see long-continued disturb- 
ance of function in any other organ, end ultimately 
in change ofstructure. But these are consequences, 
not causes of the orginal malady. Thus, we see 
hypochondriasis occasionally terminate in mon- 



99 ON MORBID SENSIBILITF OP 

omania, or insanity on a single point, and then it is 
probable that actual lesion of the brain or its mem- 
branes has taken place. None of the modern doc- 
trines, however, are new. Hippocrates, Galen, and 
Areteus, attributed hypochondriasis to black bile — 
the hepatic doctrine of our own time. Diodes 
placed the seat of the disease in the stomach, oth- 
ers in the liver, mesentery, and spleen. Willis con- 
sidered it an affection of the brain and nervous sys- 
tem, (the doctrine of Falret,) while Sydenham 
made it to depend on debility, and on irregularity 
of the animal spirits. Boerhaave believed in the 
existence of a tenacious matter obstructing the ves- 
sels of the hypochondria. Lower accused the state 
of the blood, and Hoffman believed that the disease 
often depended on chronic inflammation of the 
mucous membrane of the intestines — the present 
doctrine of Broussais.* 

The following opinion of Villermay, precisely 
accords with my own observation and experience. 
" Ce n'est pas dans l'alteration du tissu nerveux lui- 
meme, que reside la cause immediate de cette ne- 
vrose; c'est dans une affection des proprieties vi- 
tales des nerfs de la nutrition; aussi l'on recon- 
nait generalement pour siege primitif de Phypoch- 
ondrie, les visceres abdominaux, specialement Pes- 
tomac afectes dans leurs sensibilite organique." 
This appears to me the true state of the case. 

I have already observed, that mental anxiety, too 
much exercise of the intellect, and too little exer- 
cise of the body, were the chief causes, in this, 
and, indeed, in all other countries, of the various 
phenomena of hypochondriasis; and that a morbid 
sensibility of the nerves of the stomach and bowels, 
with or without the usual symptoms of disordered 
digestion, was the leading feature of the disease, 

* See Louyer- Villermay, Trait surles Maladies Nerveuses. — 1816 



THE STOMACH AND BOWEL3. 100 

and the cause of the varied and endless train of 
symptoms which develope themselves in the mind 
and in distant parts of the body. 

Hypochondriasis is generally represented as com- 
mencing with some unequivocal affections of the sto- 
mach, as sense of uneasiness and distention after 
eating, slow and difficult digestion, eructations of 
air, acid, or portions of the food, flatulence in the 
bowels some hours ofter eating, fur on the tongue, 
especially in the morning, with a pasty disagreeable 
taste in the mouth, occasional nausea or even sick- 
ness of stomach, appetite either defective, irregular, 
or voracious, disagreeable odour on the breath, ir- 
regularity, but generally constipation of the bow- 
els, &c. — in short, the usual symptoms of indiges- 
tion. This may be the case, especially when ari- 
sing from physical causes, as intemperance and the 
like ; but at this early period, the extensive morbid 
sympathies are not established, the mental phenom- 
ena are not developed, and the individual, in short, 
is not hypochondriacal. But let this state of the di- 
gestive organs continue, for a certain period, and 
become aggravated, or let the causes be of a moral 
rather than a physical nature, as losses in business, 
crosses in love, disappointed ambition, or a thou- 
sand other mental afflictions, and then we shall find 
that the original train of corporeal disorders in the 
digestive organs is masked, or almost entirely dis- 
appears, under the complicated sympathetic affec- 
tions of remote parts. These sympathetic affec- 
tions are of a mixed character, corporeal and men- 
tal. In proportion as the causes were of a physical 
nature, so will be the predominance of the sympa- 
thies : — and, on the other hand, in proportion as 
they were of a moral nature, so will the sympa- 
thetic disorders be of a predominant intellectual 
character. In general, however, they are mixed. 
There will be palpitation and irregular action of 



101 ON MORBID SENSIBILITY OP 

the heart, cough, or other affection of the lungs — 
pain, heat, confusion, giddiness, noise, and a thou- 
sand other sensations about the head, uneasiness or 
pain in the region of the kidneys, the bladder, the 
rectum, or other parts of the body. In short, there 
is not an organ or spot of the whole human fabric 
which is not liable to become the seat of some mor- 
bid feeling, more tormenting than the most dan- 
gerous organic disease : so true is the expression of 
Mangetus : — " Signorum maximus est numerus, 
nix enim ulla pars corporis est quoz vim hvjus 
morbi effugit, prozcipue si morbus radices alte 
egerit." 

In the more advanced, or rather in the higher 
grades of hypochondriasis, especially if the morbid 
sensibility of the nerves of the digestive apparatus 
has been induced by moral affections of a trying na- 
ture, then the intellectual functions, the sensations, 
the perceptions, the meditations, are singularly dis- 
ordered. The nerves of sense, under these condi- 
tions, are morbidly susceptible to an astonishing de- 
gree. Thus, any sudden noise will make such an 
impression as if the organ of hearing was distribu- 
ted over the whole surface of the body. It is said 
of the hypochondriac that he exaggerates every 
feeling: but the truth is, that every sensation is ex- 
aggerated, not by his voluntary act, but by the 
morbid sensibility of his nerves, which he cannot, 
by any exertion of the mind, prevent. Hence his 
imagination is perpetually placing these morbid 
feelings in different parts of the body to the ac- 
count of some serious organic disease. The nerves 
of the hypochondriac are so painfully susceptible of 
every impression, and the mind is so harrassed by 
these distressing appeals from the senses, that the 
individual endeavours to avoid society, from the 
fear of collisions; or if the ties of friendship or other 
motive draw him into conversation, he is perpetu 



THE STOMACH AND BOWELS. 102 

ally describing his complaints, or dwelling on their 
fatal tendency. Finding but little relief from medi- 
cine, and indeed seldom giving any medicine a fair 
trial, while the consolation of friends generallly in- 
creases his miseries, as consisting of raillery, or at- 
tempts to persuade him that his complaints are ima- 
ginary, he flies from one medical man to another, 
and not unfrequently becomes the dupe or the vic- 
tim of quacks, who humour his ideas ; confirm him 
in the belief of the reality of the evil he appre- 
hends ; and delude him by unequivocal assurances 
of cure. It is no wonder that, tired out with dis- 
appointed expectations, and tortured with wretched 
feelings, his life should become burthensome to 
him, and that he should look upon death as the 
only deliverer from complicated and incurable ills. 
It is not one of the least curious anomalies in this 
strange malady, that the individual who appears so 
solicitous about every symptom of his complaint; 
and consequently about life, should not very rarely 
be the one to commit suicide. The fact is, that 
hypochondraicism, in its highest degree, passes into 
monomania — and it is despair of relief that drives 
the sufferer to fly into the arms of death to escape 
the miseries of existence. I shall, therefore, pass 
over those aggravated cases of hypochondriasis as- 
similating with insanity, in which, for instance, the 
patient fancies the existence of something quite im- 
possible, as that his legs are made of glass or the 
like, in order to make a few observations on far 
lower but far more frequent grades of the disorder, 
characterized by mental despondency, fits of pas- 
sion, irritability of temper, gloomy anticipations, 
melancholy moods, alternate sallies of good and bad 
spirits, &c. &c. which meet the eye every hour of 
the physician's life. In civilized life, indeed, what 




103 ON MORBID SENSIBILITY OP 

with ennui and dissipation in the higher ranks* — 
anxiety of mind, arising from business, in the mid- 
dling classes — and poverty, bad food, bad air, bad 
drink, and bad occupations, among the lower clas- 
ses, there is scarcely an individual in this land of 
liberty and prosperity — in this kingdom of " ships, 
colonies, and commerce," who does not experience 
more or less of the "English malady" — that is to 
say, a preternaturally irritable state of the nervous 
system, connected with, or dependent on, morbid 
sensibility of the stomach and bowels. 

As it is more easy to remove disorders in the be- 
ginning than when they have taken deep root, so it 
is very important, both to the patient and practi- 
tioner, to detect the lighter shades of what may go 
on in the end to confirmed hypochondriacism, of 
which there is not a more terrible or more untract- 
able malady incident to man. It is fortunate for 
the patient when unequivocal disorder of the sto- 
mach and digestive organs is an early feature of the 
disease, for then his attention is directed to the root 
of the evil. It is, also, a sign that physical causes 
are operating deleteriously, and these can always be 
more readily combated than moral causes. But 
when the disorder in the digestive organs is not 

* There are but few, who have led a very active life, whether in 
the army, the navy, the colonies, or in commercial pursuits at 
home, who are capable of enjoying the anticipated pleasures of re- 
tirement afterwards. We, therefore, find a great proportion of 
these in a state of hypochondriacism, more or less prominent. — 
Exercise, whether of body or mind, is the great antidote, when in 
moderation, to this state ; but few will take regular exercise, men- 
tal or corporeal, without some distinct pursuit, which those who are 
retired have not. Besides, as it is only the wealthy who volunta- 
rily retire, they think one great object of their remaining days is to 
live well ; and this very indulgence leads to more misery than they 
ever experienced in the pursuit after riches. Thus the physique j 
poisons their morale. Those, on the other hand, who are forced to j 
retire from military service, in consequence of their services being I 
no longer wanted, become discontented as well as idle, and a state > ! 
of hypochondriacism very generally succeeds. Of these we see 
daily instances, in these piping times of peace. 



THE STOMACH AND BOWELS. 104 

very prominent, or is wanting, and the malady- 
shews its first approaches through the medium of 
the mind, or of distant sympathies in the body, the 
real state of the case is seldom ascertained till seri- 
ous mischief is done. 

Whenever, therefore, a man finds any alteration 
in his temper or moral feelings, there being no 
adequate moral cause, he should suspect some phy- 
sical cause. Let him then narrowly watch the 
state of these deviations from natural temper or 
feelings, after free living and after abstinence ; af- 
ter complicated dishes and after plain food ; after 
wine and after water. If he does not find an in- 
crease or diminution of his mental or corporeal 
ailments, according as he leans to the one side or to 
the other of those points of regimen, then I am no 
observer. But I am confident that he will readily 
recognize the correspondence between cause and 
effect ; and if so, how can we have a better test for 
the nature of the complaint, or a firmer basis for 
the treatment? Even if the original causes be 
purely of a moral nature ; as, for instance, severe 
losses in business, — still the mental despondency is 
aggravated by the morbid sensibility of the stom- 
ach; and this morbid sensibility is mitigated or 
exasperated by the quality and quantity of our food 
and drink. The physician cannot cure the moral 
cause that preys upon the mind, and through that 
medium injures the body ; but he can, in a great 
measure, prevent the re-action of the body on the 
mind, by which re-action the moral affliction is 
rendered infinitely more difficult to bear. Thus a 
man loses by speculation a certain sum of money, 
which makes a considerable impression on his 
mind, and depresses his spirits. After a while he 
finds that time, instead of healing the wound which 
misfortune had inflicted, has increased it; and that 

K 






105 ON MORBID SENSIBILITY OF 

what he could look upon with some degree of for* 
ti-tude, in the beginning, is now become such a 
source of despondency that it haunts him by day 
and by night, and is for ever uppermost ia his 
thoughts, and even his dreams. He finds, moreo- 
ver, that some days he can view the misfortune 
with courage, and spurn the idea of giving way un- 
der it ; while, on other days, it presents itself in 
the most frightful colours, and he seems complete- 
ly deprived of all fortitude to resist its overwhelm- 
ing influence. This is a true copy, of which I have 
seen many originals, during the late commercial 
distresses, and ruinous speculations. What does ife 
teach us ? Why, that the moral affliction was borne 
with comparative ease till the digestive organs 
were impaired through the agency of the mind,, 
when re-action took place, and impaired, in turn,- 
the mental energies. But how are we to account 
for the fact that, one day the individual will evince 
fortitude, and the next despair; all the attendant 
circumstances of the moral evil remaining precisely 
as they were? It can be clearly accounted for by 
the occasional irritation of food or drink exasperat- 
ins: the morbid sensibility of the stomach, and 
thereby re-acting on the mind. This temporary 
irritation over, the mind again recovers a degree of 
its former serenity, till the cause is re-applied. I 
was led to this solution of the enigma some years 
ago, by observing that a very aged hypochondriac 
was every second day affected with such an exaspe- 
ration of his melancholy forebodings, that he did 
nothing but walk about his room wringing his 
hands, and assuring his servants that the hand of 
death was upon him, and that he could not possibly 
survive more than a few hours. Under these gloo- 
my impressions he would refuse food and drink, 
and, in fact, give himself up for lost. The succeed- 
ing sun,- however,- would find him quite an altered 



THE STOMACH AND BOWELS. 106 

man. The cloud had broken away ; hope was re- 
kindled ; and the appetite for food and drink was 
indulged ad libitum. Next morning, all tfould 
again -be despair, and nothing but death could be 
thought of. So he went on, aa regular as light and 
darkness. But if, on the good day, he could be 
kept on a very small portion of food, and the bottle 
unopened, the next would be good also. This, 
however, could seldom be done 5 for as soon as he 
felt a respite from his miseries, procured by one 
da}^'s abstinence, he returned to his usual indulgen- 
ces and again irritated his stomach and bowels, and 
through them reproduced the blue devils in the 
mind. Another curious phenomenon was observed 
m this case, and, indeed, I have -seen the same in 
many others : — namely, that any purgative medi- 
cine, which operated at all briskly, brought on an 
exasperation of the mental depression. He was al- 
ways better when the bowels were constipated ; 
clearly shewing that whatever irritated the nerves 
of the alimentary canal, whether as food or as phy- 
sick, increased the mental malady. Indeed, the 
abuse of irritating purgatives is one of' the common 
physical causes of this morbid "sensibility, and 
should be carefully avoided in the treatment of the 
disease. 

I have known many instances where individuals., 
having this morbid sensibility of the gastro-intesti- 
aal nerves, experienced, after eating certain arti- 
cles of difficult digestion, such a state of irritability 
of temper, that they were conscious of the danger 
they ran, by the slightest collision or contradiction 
from even the nearest relations, and, therefore, 
avoided society till the fit went off. One gentleman 
in this state always caused liis servants to tie his 
two hands together, lest in the paroxysm of irrita- 
tion (without any ostensible cause) he should cut 
his throat er -otherwise commit suicide. .There 



tt)7 ON MORBID SENSIBILITY OP 

was great difficulty in keeping this gentleman front 
wine in excess. Tartar-emetic was, therefore, put 
into it unknown to him, and produced vomiting 
every time he took it. He persevered for a day or 
two, and then took such a disgust to his usual be- 
verage that he could not bear the sight of it. This 
also effectually checked his appetite for food ; and, 
for a time, there was almost a total cessation of the 
irritability of temper and paroxysms of agitation, 
till he got back to excesses of the table. 

In fine, it is impossible to enumerate the thou- 
sand ways in which different people are affected in 
their tempers and dispositions from this morbid 
sensibility of nerves ; and, that without any mate- 
rial feeling of discomfort in the very parts where 
the morbid sensibility exists. They cannot, there- 
fore, point out the causes of their wretched feeling, 
nor can their medical attendant often detect it 
Their complaints are considered imaginary, and 
pass unpitied ; and the unhappy victim of a real 
physical malady, which preys on his vitals, is thus 
set down as a hypochondriac, and so bantered and 
ridiculed by his friends, that the world is to him a 
purgatory, from which he has little regret in party- 
ing ! 



TREATMENT. 



The pains which I have taken to investigate the 
causes and the nature of the class of diseases which 
has passed under review will greatly abridge what 
I have to say as to the treatment The real and 
efficient remedies are very few in number, and, in 
this respect, they form a striking contrast with the 
innumerable forms and phenomena of the disease 



THE STOMACH ASTD BOWELS. 108 

which they are prescribed. Speaking general- 
ly, I verily believe there is more harm than good 
done by the farrago of medicines which are thrown 
into the stomach of a dyspeptic patient, at a time, 
too, when that organ will scarcely digest the lightest 
food. 

I think I have proved that, whether there be os- 
tensible disorder of the digestive function, or only 
the manifestation of morbid sympathies at a dis- 
tance, or both at the same time, there is a morbid 
sensibility of the gastric and intestinal nerves: and 
hence, the first and most important indication is to 
lessen that sensibility, by withdrawing the causes 
of irritation, and applying such remedies as have 
the effect of diminishing irritability. If the sour- 
ces of irritation eould be completely withdrawn, 
Nature would generally effect a cure, without the 
assistance of medicine. But as these are sometimes 
of a moral, as well as a physical nature, we have but 
little power over the former, and are, therefore, on- 
ly able to mitigate the symptoms. As it Is on the 
regulation of diet that oar chief hopes of cure 'must 
rest, and as the system which I must insist on is 
rather rigid, I have endeavoured to shew the reason 
why this apparently severe discipline is absolutely 
necessary, in order to stimulate the practitioner to 
fearlessly prescribe, and the patient to implicitly 
adopt It 

There Is a great error committed every day, in 
flying to medicine at once, when the functions of 
the stomach and liver are disordered., the secre- 
tions unnatural, and the food Imperfectly digested. 
Instead of exhibiting purgatives day after day to 
carry off diseased secretions, we should lessen and 
simplify the food, in order to prevent the forma- 
tion of these bad secretions. In doing this we have 

K 2 



109 ON MORBID SENSIBILITY OP 

great prejudices to overcome. The patient feels 
himself getting weaker and thinner; and he looks 
to nourishing food and tonics for a cure. But he 
will generally be disappointed in the end by this 
plan. From four ounces of gruel every six hours, 
he will, under many states of indigestion, derive 
more nutriment and strength than from half a pound 
of animal food and a pint of wine. Whenever he 
feels any additional uneasiness or discomfort in 
mind or in body after eating, he has erred in the 
quantity or quality of his food, however restricted 
the one, or select the other. If the food and drink 
irritate the nerves of the stomach, it must be redu- 
ced and simplified, down even to the gruel diet 
above alluded to. I have known dyspeptic patients 
gain flesh and strength on half a pint of good gruel 
thrice in the 24 hours ; and gradually bring the 
stomach, step by step, up to the point of digesting 
plain animal food and biscuit. On six ounces of 
animal food, a biscuit, and a glass of water, I have 
known invalids dine for months in succession, and 
attain, on this regimen, a degree of strength and a 
serenity of mind beyond their most sanguine hopes. 
In all or any of the various forms of dyspepsia 
which have been described, then, the diet is the 
first thing to Deregulated. But it is quite prepos* 
terous to prescribe a certain quantity, or even qua- 
lity of food/nd drink, till the power of the diges- 
tive organs' is ascertained. I have repeatedly point- 
ed out the criteria by which the patient, as well as 
the practitioner, may easily determine this impor- 
tant point. I care not if the dyspeptic invalid be- 
gins with a pound of beef-steaks, and a bottle of 
Port wine for his dinner. If he feel as comforta- 
ble at the end of two, four, six, eight, or 12 hours 
after this repast, as he did between breakfast and 
dinner of the preceding day, he had better continue 
his regimen, and throw physic to the dogs. But 



THE STOMACH AND BOWELS. 110 

if, a few hours after his dinner, he feel a sense of 
distention in the stomach and bowels, or any of 
those symptoms of indigestion which have been 
pointed out ; if he feel a languor of body, or a clou- 
diness of the mind ; if he have a restless night; if 
he experience a depression of spirits, or irritability 
of temper next morning, his repast has been too 
much, or improper in kind, and he must reduce 
and simplify till he come to that quantity & quality of 
food and drinkfor dinner, which will produce little or 
no alteration in his feelings, whether of exhilaration 
immediately after dinner, or of discomfort some 
hours after this meal. This is the criterion by 
which the patient must judge for himself. The 
scale of diet must be lowered and simplified down 
to water gruel, if necessary ; otherwise a cure can 
never be expected. Speaking generally, the dys- 
peptic invalid may commence the trial with from 
four to eight ounces of plain and tender animal 
food, with stale bread, and few or no vegetables, 
at two o'clock, or as near that hour as possible, 
drinking, after the meal, a table-spoonful of brandy 
to two or three wine-glassfuls of water. If, after 
this, he feels light, and rather inclined to exercise 
or amusement than to take a nap on the sofa, he has 
hit the point; and to that system he should rigidly 
adhere. If he feel oppressed in body, or discomfit- 
ed in mind, he must reduce the quantity gradually ; 
if he feel a sense of emptiness, or faintness, he must 
increase the quantity of his food ; but this will very 
seldom be necessary. If the weak brandy and wa 
ter will not be taken, sherry and water, (a wine- 
glassful to the tumbler) may be allowed ; but it is 
not so salutary as the former. Every thing that 
is taken beyond this, at dinner, is at the patient's own 
peril ; and if he prefer wretched health of body and 
mind to a relinquishmentof the momentary gratifica- 
tion of sensual indulgence at table, let not thephysi- 



^11 ON MORBID SENSIBILITY 05? 

cian give his sanction to such self-destruction. I have 
distinctly said that the invalid may eat and drink as 
much as he pleases ; provided he experience no 
increase of his morbid feelings from food and drink, 
within the 24 succeeding hours. If he do feel an 
increase of these, the necessity of the restriction 
which I propose is self-evident, and so far from be- 
ing the imposition of a penance, it is, in reality, 
the removal of one. Let it be remembered that I 
am speaking of the dyspeptic stomach, and not of 
that which is in the enjoyment of ail its healthy 
powers and of all its natural sensibilities. But the 
invalid may ask — "Can I not have my ailments re- 
moved without abridging my appetites?" No! 
And the practitioner, who undertakes the treat- 
ment under such conditions, betrays either a want 
of principle or a want of judgment. 

Well, then, the patient adopts such a simple 
and abstemious plan of diet that he feels no augmen- 
tation of his sufferings after food ; but still he is 
far from well. He escapes those periodical aggra- 
vations of his complaint, but the medium ratio re- 
mains as before. There must be time for all things. 
Effects do not always cease when their causes are 
removed. It may have taken a long application of 
noxious agents to produce the morbid sensibility of 
the nerves, and it will require some time to rein- 
state them in their natural tone of feeling. Besides, 
the causes that originally produced the disorder 
may have been of amoral nature, and may still con- 
tinue to operate. In this case we can only prevent 
the aggravation by proper diet, and mitigate the 
symptoms by proper remedies. The rest must be 
left to time, and to moral means. 

Although there is much peculiarity of disposi- 
tion, in regard to diet, observable in different indi- 
viduals, and therefore some latitude to be allowed 
on this account ; yet experience has shewn that, 



THE STOMACH AND BOWELS. 112 

however the proper quantity of food may differ in 
different constitutions, there is one broad rule as to 
quality, which is seldom inapplicable to one in a 
hundred dyspeptics. 

The least irritating, and the most easily digested 
aliment is unquestionably farinaceous food, at the 
head of which we may place good grit gruel. I 
have known many who could digest only this, with- 
out unpleasant sensations in the stomach or other 
part of the body. When such is the case, the 
nerves of the stomach are in a high degree of mor- 
bid sensibility, and great caution should be taken 
not to irritate them by attempts at more nutritious 
food. No person is in danger of starvation who 
can take a pint — nay, only half a pint of good gruel 
in the 24 hours. Arrow-root, sago, tapioca, rice, 
salep, are all in the same class; but few of them will 
bear repetition so well as gruel. A little sugar, 
and a tea-spoonful of brandy in each cup of the 
gruel may be permitted ; but the brandy may be 
safely dispensed with in general. 

When the nerves have been kept free from irri- 
tation for a certain time by this mild regimen ; 
when the tongue cleans ; the sleep becomes more 
refreshing; and the intellectual feelings and func- 
tions more tranquil ; beef-tea may be mixed with 
the gruel ; then half an ounce or an ounce of 
chicken ventured on, and gradually increased. 
Whenever any uneasy sensations, of mind or body, 
occur, within the 24 hours after this trial of animal 
aliment, it should be decreased; or, if that will not 
do, wholly omitted, and the farinaceous food re- 
sumed. If no bad effects follow, the quantity of 
chicken may be progressively increased to six or 
eight ounces, with stale bread — but not too much 
of that. No particle of any other vegetable matter 
should yet be ventured on. While the farinaceous 
regimen is necessary, no drink should be taken, 



113 ON MORBID SENSIBILITY OP 

unless thirst be urgent, when barley water or toast 
and water in small quantity may be allowed. 
When the chicken can be borne, the drink should 
vary in quantity, according to the feelings of 
thirst, and the number of ounces of the animal diet 
which can be tolerated. Thus, if the patient can- 
not take more than an ounce of animal aliment, a 
wine-glassful of water, with a tea-spoonful of brandy 
in it, is as much as should be taken after the re- 
past, unless thirst should urge, when some toast 
and water without brandy may be taken. If eight 
ounces of chicken can be borne with impunity, a 
tumbler of water, with a table-spoonful of brandy, 
is a fair allowance. 

From poultry, the dyspeptic should cautiously 
ascend to mutton or game, dressed in the simplest 
manner, and still with stale bread or biscuit. I 
would strongly advise that the quantity should 
never exceed half a pound in weight, even when 
that can be borne without a single unpleasant sensa- 
tion succeeding. It is quite enough, and generally 
too much. The invalid will acquire a degree of 
strength and firmness, not fulness, of muscle on 
this quantity, which will, in time, surprise his 
friends, as well as himself. When arrived at the 
power of digesting six or eight ounces of mutton, 
he may vary the kind of animal matter considera- 
bly. Lamb, hare, tender beef, tripe ; nay, venison 
may be taken, provided the golden rule be obser- 
ved of always keeping to the quantity which pro- 
duces no languor after eating ; no unpleasant 
sensation of mind or body during digestion.* 

* It may seem strange that I have not included fish in the list of 
edible matters for the dyspeptic. But, in truth, it is a very precari 
ous, if not dangerous species of food in weak stomachs. {Salmon is 
extremely improper, and even the white fish is very apt to turnrancid 
and greatly irritate the gastric and intestinal nerves. I would advise 
the invalid to abjure fish. Without butter or other sauces it is in- 
sipid ; and with these additions it is poison. I have known very 



TK£ STOMACH AND BOWELS. U4 

I cannot urge this rule too strenuously on dyspep- 
tics ! Their happiness ; perhaps their welfare; and 
the happiness and welfare of many who are connec- 
ted with them, depend on its strict observance. 

It is needless to dwell on the endless catalogue 
of improper dishes. All are improper for the dy- 
speptic, or at least dangerous, that are not included 
in the above. Even a mealy potatoe will often ir- 
ritate the nerves of the stomach (without any per- 
ceptible sensation there) and pass undigested, after 
producing a great deal of wretched feeling in dis- 
tant parts of the body. The same may be said of 
every kind of fruit and vegetable. There is such a 
tendency to form acidity in the weak and irritable 
stomach ; vegetable matters are so prone to acidify ; 
and acid is so peculiarly offensive to the morbidly 
sensible nerves of the primae viae, that the dyspep- 
tic invalid cannot be too much on his guard against 
fruit and vegetables of every description, however 
innocent they may seem to be, as connected with 
disagreeable feelings in the stomach itself. As for 
cheese, pickles, nuts, onions, and a variety of pro- 
vocatives, they are rank poison in dyspepsia, and 
as such should be religiously avoided. 

In respect to drink, my firm conviction is that 
water is the best ; and till the habit of water-drink- 
ing can be acquired, the dilute mixture of brandy 
and water is the next best beverage. Still I have 
no objection to a glass or two of sherry, under the 
guidance of the criteria which I have so often laid 
down. The sooner, however, that every species of 
stimulating drink can be laid aside the better. A 

serious attacks of indigestion, in its febrile form, produced by tur- 
bot and even cod. Shell-fish, as crab, lobster, and oysters, are, in 
general, much less injurious, and can be borne without detriment 
by the dyspeptic stomach, when the irritability of its nerves has 
been a good deal subdued by a proper course of diet and medicine 
previously. 



|15 ON MORBID SENSIBILITY OP 

ctip of coffee after dinner is far preferable to wine. 
Malt liquors are quite out of the question. 

The other meals are of some consequence to be 
attended to by the'dyspeptic invalid. In the morn- 
ing, if the nervous irritability is not in the highest 
degree, (necessitating the use of gruel,) coffee or 
Bohea tea, with well toasted bread, cold, and very 
little butter ; or what is better, a little cold meat, 
may be taken ; and nothing more till dinner, if at 
two o'clock. Where tyrant custom compels to 
dine late, a slice of cold meat and biscuit should be 
taken at one o'clock. The tea should be the same 
as the breakfast, but without animal food.— And a 
cup of gruel is the best supper. Where farinaceous 
food call be relished for breakfast, it is certainly 
better than tea j and the milk or cream should be 
sparingly used. 

By adherence to the foregoing plan, varying the 
quantity according to the feelings subsequently ex- 
perienced, the surest foundation is laid, not only 
for health, but for happiness. Upon a regimen of 
this kind, the body will be brought to the greatest 
degree of permanent muscular strength, of which 
the individual constitution is susceptible ; and the 
intellectual powers will be raised in proportion. 
Equanimity of mind will be attained, if attainable 
at all • and where moral causes of irritation ot 
affliction cannot be avoided, they will be greatly 
neutralized. Under such a system of diet, the 
corporeal frame will be rendered more capable of 
undergoing fatigue; and the mind more able to 
resist misfortune, than by the richest dishes and 
most luxurious wines.* 

* Captain Head states that, when he commenced his travels m 
South America, he was quite unable to undergo the necessary ex- 
ertion, till he adopted the plan of living on plain animal food and 
water only. He could then, in a short time, tire out horses in bia 
pedestrian marches. 



THE STOMACH AND BOWELS. 116 

The rigid system which I have proposed is not 
the creature of speculation, engendered in the closet. 
It is that which many, to my knowledge, have 
adopted with the most perfect success ; it is that 
by which I have conquered the most intense degree 
of dyspepsia in my own person. Those who have 
courage and perseverance to reap the fruits of such 
a system, will hardly be induced to change it, how- 
ever strongly they may be tempted by the luxuries 
of the table, and the seductions of convivial society. 
It would be well for those in the enjoyment of pre- 
sent health, if they employed it as a preservative 
of that invaluable blessing ! But this I do not ex- 
pect. I am addressing those who have tasted the 
bitter cup of sickness ; and especially those who 
have experienced the horrors of dyspepsia. The 
latter alone can appreciate the luxury of immunity 
from the terrible feelings of mind and body engen- 
dered by that worst of human afflictions. 

When a man has escaped the miseries of dyspep- 
tic feelings, and brought the sensibilities of his 
stomach to a natural state, by great attention to 
diet, he should be careful how he deviates from the 
rigid regimen by which he was restored to health. 
Nothing is so liable to relapse as dyspepsia ; and 
indulgence in variety of dishes, or vegetables and 
fruit, will be almost certain of making the indi- 
vidual pay dear for the experiment. But it is of 
still more importance to keep to a low quantity 
of food. The least over-exertion of the stomach in 
mastering a larger proportion than it can easily di- 
gest, will be sure to re-kindle the morbid sympa- 
thies of the body, and the wretched feelings of the 
mind. 

MEDICINAL TREATMENT. 

The foregoing rules of diet will apply to almost 
all cases and stages of dyspepsia, whether consis- 
L 



117 ON MORBID SENSIBILITY OF 

ting in morbid sensibility of the gastric nerves, 
without apparent disorder of function ; or accom- 
panied by the various symptoms of indigestion and 
biliary derangement. This dietetic regulation is the 
basis of the treatment. Without it, no effectual 
cure can be accomplished ; and by it alone, nine 
cases in ten of common indigestion, in its earlier 
stages, might be removed. But much auxiliary as- 
sistance may be derived from a judicious application 
of medicine. 

After adjusting the subject of diet, our attention 
should next be directed to the state of the secre- 
tions. The mode of ascertaining their habitual 
condition is too often erroneous. Thus, a brisk 
purgative is given, and then the secretions are ex- 
amined. But the same medicine, if given to a per- 
son in health, would very frequently evacuate mat- 
ters that would be considered morbid. Besides, 
the action of purgatives will often rouse the liver 
and other glands to pour forth secretions very dif- 
ferent in quantity as well as quality from what are 
habitually secreted. The secretions cannot, in fact, 
be ascertained by one or two inspections. They 
should be examined when medicine has been taken, 
and when no medicine has been taken. They 
should also be examined after the operation of dif- 
ferent kinds of medicine. Mercurial aperients will 
bring down bile that is habitually defective. — Rhu- 
barb will tinge the secretions yellow that were pre- 
viously pale ; magnesia will render the motions 
pale that were formerly dark-coloured ; salts will 
expel watery motions ; aloes, solid evacuations. 
From this it will be seen, how necessary it is to 
think a little before a plan of medicine is determin- 
ed upon. 

When there is unequivocal disorder of function 
in the liver and digestive organs, as ascertained by 
the symptoms formerly described, it will generally 



THE STOMACH AND BOWELS. 118 

be found that the secretions are unhealthy. The 
change of diet will, in itself, greatly correct this 
morbid condition of the secretions; but, in the 
mean time, they must be daily removed from the^ 
alimentary canal, in order to take away one source 
of irritation. 

In doing this, there is much caution necessary. 
Infinite mischief, as I have stated before, is daily 
occasioned by the indiscriminate employment of 
purgative medicine, in dyspeptic complaints. Bad 
secretions may be thus removed, but their repro- 
duction will never be thus prevented. It is by 
withdrawing the sources of irritation, and gradually 
improving the functions of the liver, the stomach, 
and the intestinal canal, that the formation of mor- 
bid secretions can be arrested. Purgation, there- 
fore, should be rarely employed. It may be pro- 
per, just at the beginning, to clear the alimentary 
canal of all its lurking contents ; but, after this, I 
do maintain that the main object is to produce but 
one evacuation daily, and that of a solid, rather than 
a liquid consistence. If practitioners knew the 
misery that is often produced by an irritating ca- 
thartic medicine in dyspeptie and hypochondriacal 
complaints, in this country, they would be more 
sparing than they are of their calomel at night and 
black draught in the morning. 

Experience has shewn, that there are some medi- 
cines which produce little irritation in the stomach 
and upper bowels, and act principally on the colon 
and rectum, as, for instance, aloes and sulphur. 
Jalap, calomel, salts, senna, antimony, and many 
other purgatives, produce a good deal of disorder 
in the stomach and along the whole eourse of the 
alimentary canal, causing a copious secretion from 
the glands and secreting surfaces of these parts, as 
well as of the liver. They are very useful, upon 
occasions, to remove all offending matters, but 



119 ON MORBID SENSIBILITY OF 

should not be often employed. A combination of 
several different kinds of aperient medicine, that 
will act mildly, but gradually, along the whole line 
of the digestive apparatus, is far preferable to any 
one medicinal substance. Simplicity of prescrip- 
tion is very generally, on this point, accompanied 
by inefficiency of the effect designed. In dyspep- 
tic cases, and especially where there is morbid sen- 
sibility, in any considerable degree, in the stomach 
and bowels, it is of great consequence to join 
hyosciamus, or some gentle anodyne, with the 
aperient. When the morbid sensibility is not in 
great degree, the anodyne may be left out. The 
following formulas may be found pretty generally 
applicable as habitual aperients. 

(No. 1.) 

Jfc. Ext. Aloes . . . 9ss. 

Jalapii, (resinos) gr. vj. 

Col. compos. . gr. x. 

Pil. Hydrarg. . . gr. vj. 

Ipecac. Pulv. « . gr. j. 

01. Cassias . . . gt. iij. 

M. ft. Pil. x. Capiat j. ij. vel iij. horasomni. 

These pills should be taken according to the ef- 
fects they produce. If one be sufficient to procure 
one easy evacuation the succeeding morning, well 
and good. If not, two, three, or any number may 
be taken, so as to effect the purpose desired. If 
much irritation prevail, from three to five grains of 
extract of hyosciamus should be taken at night with 
the pills. 

Of the two following forms, the first (No. 2) is a 
brisk purgative, that may sometimes be necessary, 
where considerable torpor of the lower bowels pre- 
vails. 



THE STOMACH AND BOWELS. 120 

(No. 2.) 

Jfc. Extracti Colocynth. comp. £j. 

Jalapii . . . . gr. vj. 

Pulv. Scammon. compos, gr. x. 
Sub. Hydrargyri . . . gr. x. 
Antimon. Tart. . . . gr. j. 

Sapon. Venet gr. v. 

01. Cassiae gt. iv. 

M. ft Pil. xv. quarum capiat j. ij. vel iij. hora somni. 

But as the stomach and bowels of some dyspep- 
tics are extremely tender, it is necessary to have a 
milder form of aperient than any of the above. 

(No. 3.) 

Jt. Ext. Rhei . . 9j. 

Aloes . . gr. v. 

Pil. Hydrarg. . gr. v. 
01. Cassiae . . gt. iij. 
M. ft. Pil. x. Capiat i. vel. ij. pro dosi. 

There will be many cases where the irritability 
of the stomach and bowels will not bear more than 
a few grains of rhubarb and magnesia, without pro- 
ducing much distress. Where acidity prevails 
much, with disposition to pain and flatulence in the 
stomach, the following will be found a useful form 
of medicine. 

(No. 4.) 

J£. Magnes. Carbonat. . 3ss. 

Sulphatis . 3 iij. 

Spir. Ammon. Aromat. 3j. 
Tinct. Rhei . . . gss. 

Hyosciam. . Sss. 

Aquae Menth. Sativae §iv. 
Misce ft. Mistura, cujus capiat coch. i. mag. bis 
terve in die. 
L 2 



121 ON MORBID SENSIBILITY OF 

. But, in fact, there is great difficulty in adjust- 
ing the aperient to the state of the case, so as to 
fulfil the essential indication — that of moving the 
bowels once daily, and always with as little irrita- 
tion as possible. Whenever thin or watery mo- 
tions are produced, more harm than good will be 
done. 

In proportion as the biliary secretion is derang- 
ed, the proportion of the mercurial must be increas- 
ed ;* but where there is no appearance of the liver 
being in fault, the less mercurial the better, espe- 
cially where the nerves of the stomach exhibit 
symptoms of much sensibility. In such cases, the 
following form of exhibiting the taraxacum (dande- 
lion) will be found very advantageous. 

(No. 5.) 

JL Infusi Taraxaci . . giv. 

Extracti Taraxaci, . gij. 

Carb. Sodae . . %sp. 

Tart. Potassae . . siij. 

Tinct. Rhei . . 3iij. 

Hyosciam. . n^xx. 

Misce, fiat Mistura, capiat tertiam partem ter die, 

* It may, in some cases, be prudent to touch the mouth with 
mercury ; but then the disease is hepatitis rather than dyspepsia. 
When this course is necessary, the patient snould be apprised of 
the circumstance, and warned to keep himself confined to the 
house, till the medicine is no longer reqnired. Where dyspepsia 
attends the hepatitis, as is almost always the case, the blue pill is 
preferable, in this country, to calomel, and should be gradually, 
steadily introduced till the mouth becomes sore, or the evacua- 
tions yellow and feculent. When this takes place, the symptoms 
of hepatitis generally vanish.- It is in such cases, that the nitro- 
muriatic acid bath, applied to the feet, legs, and arms, is often of 
very considerable benefit. This remedy, like most others, was 
overrated on its first introduction, and has, consequently, fallen al- 
most entirely into disuse — unmeritedly so. Its application is at- 
tended with too much trouble for patients and practitioners in 
general ; and this is one cause of the infi equency of its employ- 
ment. It ie not so well calculated for the morbid sensibility of the 






THE STOMACH AND BOWELS. 122 

Before taking leave of the subject of aperients, I 
may add, that the use of injections, as auxiliaries, 
should not be neglected. In high grades of gastric 
and intestinal irritability, it is hardly possible to 
give any aperient by the mouth — even castor oil — 
'without producing disagreeable effects ; and here 
the employment of injections is of great advantage. 
The rigid system of diet is our sheet anchor, till 
the morbid sensibility of the nerves is lessened or 
removed, and then aperients may be used with 
greater safety and greater latitude.* 

But are we possessed of no means of reducing this 
morbid sensibility of the nerves, in addition to the 
plan of unirritating diet? We certainly can great- 
ly assist the dietetic regimen by other means. The 
effect of counter-irritation is often very conspicu- 
ously beneficial. A small plaster of tartar emetic 
and Burgundy pitch applied to the pit of the sto- 
mach is one of the most powerful cOunter-irritants 
we possess, and is far superior to blisters. A scru- 
ple of the tartrate of antimony to each drachm of 
the Burgundy pitch, will, in two or three days, 
produce a copious crop of pustules, that will con- 
tinue to discharge for a week afterwards, and af- 

stomach and bowels, of wbieh I have been treating, as for a torpid 
state of the liver, a paucity of bile, and a constipated state of the 
bowels. 

* The white mustard-seed has lately attracted considerable at- 
tention ; and 1 have known a great number of dyspeptic invalids 
take it ; some with advantage, others without much effect: and. in 
a very few instances, it appeared to do harm. It certainly is not 
calculated for a very irritable state of the gastric aud intestinal 
nerves; since all spicy or hot aromatic substances are injurious in 
such cases. It is where the bowels are very torpid, the appetite 
bad, and the whole system languid and sluggish, that the white 
mustard-seed promises to be serviceable. If it keep the bowels 
open, and produce no unpleasant feeling in the stomach, alimen- 
tary canal, or nervous system, it may be taken with safety. If it 
do not produce an aperient operation it can do little good, and 
may, perchance, do miscluef. 






123 



ON MORBID SENSIBILITY OP 



ford much relief. I have no objection to a few 
leeches being previously applied to the part, espe- 
cially if much tenderness is complained of on pres- 
sure: for although irritation and inflammation are 
two very different conditions, and require different 
treatment, yet the former sometimes leads to the 
latter, and we occasionally see the two combined. 
On this account the application of a few leeches is 
a safe predecessor to the counter-irritation. 

Where irritation of the whole nervous system 
depends, as it often does, on irritation of the sto- 
mach, it will sometimes be necessary to keep up a 
steady soothing effect on the gastric nerves, by ano- 
dynes, combined with small doses of blue pill. 
The biliary secretion is sometimes so acrid that the 
patient is sensible of its descent into the duodenum, 
and experiences the most indescribably disagreea- 
ble sensations at the time, producing a kind of shud- 
der through the whole frame, and a radiation of 
morbid feelings from the region of the duodenum 
in every direction. This I experienced myself, 
and was qnite satisfied that it proceeded from the 
contact of the bile with the morbidly sensible 
nerves of the duodenum. In such cases, two or 
three grains of hyosciamus, one grain of blue pill, 
and two of the compound powder of ipecacuanha, 
every six hours, will keep the irritation in check, 
and help to correct the vitiated state of the biliary 
secretion. With these medicines, a little rhubarb 
at night, merely to ensure one action of the bowels 
daily, is all that should be taken, and this only 
when the bowels will not act spontaneously. 

Bearing in mind the intimate sympathy between 
the external surface of the body and the internal 
surface of the alimentary canal, the tepid bath is an 
important remedy, as a soother of irritability. The 
forenoon or the evening is the time to be selected, 
and the subsequent feelings of the individual will 
be the best criterion for its repetition. 



THE STOMACH AND BOWELS. 124 

I now come to an important class of remedies for 
the lessening of morbid sensibility of the nervous 
system — namely, the vegetable bitters and tonics. 
The state of the appetite being a pretty fair index 
of the state of digestion, experience, in all ages, 
has confirmed the benefit to be derived from this 
class of medicinal substances in dyspepsia, when 
carefully managed. It is a well known truth that 
debility is the parent of irritability, and it is on 
this principle that tonics can be safely employed. 
But when irritability is great, tonics do more harm 
than good, and, in fact, increase instead of dimin- 
ishing the morbid sensibility of the stomach and 
bowels. On this account they cannot be safely 
employed till the irritability is reduced to a cer- 
tain point by mild diet and by soothing medicines, 
when they may be applied with the most decided 
and indeed surprising good effects. If they are 
given before this reduction of morbid sensibility, 
they produce great disturbance in the system, and 
I am confident they frequently change irritation 
into inflammation. In this case, as in the case of 
food, the feelings of the individual are unerring 
criteria of the salutary or noxious effects of bitters 
and tonics, and these should be scrupuously atten- 
ded to by the patient and practitioner. Many hy- 
pochondriacs have been driven into a state of in- 
sanity by the stimulation of wine and tonics, when 
the morbid sensibility of the stomach was in a high 
degree. Wine and tonics, like opium, will over- 
power the sensibility of the nerves for a few hours, 
in these cases, and some sleep may follow, but the 
terrible exasperation of irritability which succeeds, 
when the first effects of stimulation are over, has 
produced many an act of suicide, besides the thou- 
sand lower grades of mental misery, to which the 
unfortunate dyspeptic and hypochondriacal invalid 
is subjected by injudicious treatment. The dread- 



125 ON MORBID SENSIBILITY OP 

ful depression of spirits and despondency of mind, 
resulting from this temporary exhilaration and ex- 
citement, are so much the more dangerous, as they 
too often lead to a repetition of the baneful causes 
that produced them. There is no point in practice 
which requires so much caution and skill in the 
practitioner as the exhibition of this class of reme- 
dies in dyspepsia and hypochondriasis. The mode 
of administering bitter tonics will be presently de- 
scribed, after premising a few observations on a 
preparation which I have sometimes employed 
with success in irritable states of the mucous mem- 
brane lining the stomach and bowels. 

I have now to draw the attention of the profes- 
sion to a medicine which I believe has never been 
employed in this class of diseases, but which, I ap- 
prehend, from what I have already seen, will be 
found a very valuable remedy. It is well known 
to surgeons that the nitrate of silver is one of the 
most powerful allay ers of irritability, when applied 
externally to painful and irritable sores. It is also 
well known that this medicine may be given inter- 
nally to the extent of several grains daily, for 
months in succession, in cases of epilepsy, and that 
without ever producing any bad effect. Indeed, it 
is now almost the only remedy on which any de- 
pendence is placed in the above-mentioned formida- 
ble complaint. My attention was first exeited to- 
wards its e,fFects on the stomach and bowels, some 
years ago, while exhibiting it to a young gentle- 
man employed in a public office of this metropolis, 
who laboured under epilepsy, and who, at the 
same time, had the usual symptoms of dyspepsia, 
and great irritability of the stomach and bowels. 
Considering the latter complaint as one of minor 
consequence, I gave the nitrate of silver alone, 
beginning with half a grain thrice a day, in crumb 
of bread, and gradually increasing it to two grains 



THE STOMACH AND BOWELS. 126 

thrice in the 24 hours, beyond which I did not car- 
ry the dose. After the first month, he had no re- 
turn of the epilepsy ; but the medicine was contin- 
ued till the expiration of three months, when it was 
finally left off. He took no other medicine what- 
ever ; and in the course of the three months he was 
completely cured of all his dyspeptic symptoms. 
I was a good deal surprised at this event, and was 
at a loss to account for the result. But several ca- 
ses have since occurred, which lead me to think, 
Jirst, that epilepsy very often depends on morbid 
sensibility of the gastric and intestinal nerves, and, 
secondly ', that it is by removing this morbid irrita- 
bility of the alimentary canal, that the nitrate of 
silver sometimes cures epilepsy. We know, for in- 
stance, that convulsions and epilepsy are frequently 
produced by worms in the first passages, although no 
symptom of sensible irritation or pain may exist 
there at the time, the worms producing the phe- 
nomena above-mentioned by their action on the spe- 
cial or organic sensibility of the parts, and thence, 
by sympathy, on the brain and spinal system of 
nerves. The removal of the worms cures the con- 
vulsions and epilepsy, by removing the cause of ir- 
ritation, and the nitrate of silver very probably 
acts, in other cases, by lessening the sensibility of 
the nerves, and thereby rendering them unsuscepti- 
ble of irritation. On this principle I have adminis- 
tered the nitrate of silver, of late, in cases where 
the morbid sensibility of the gastric and intestinal 
nerves was produced by other causes than worms, 
and gave rise to other phenomena than epilepsy, 
and hitherto with marked advantage. In one case, 
that of a lady near Greenwich, the effects of the ni- 
trate of silver exceeded my most sanguine expecta- 
tions. She had been, for years, harrassed with con- 
vulsive twitching, faintings, and a host of the most 
strange and anomalous symptoms, almost daily, 






127 ON MORBID SENSIBILITY OP 

which rendered her life miserable, and resisted 
every remedy that could be thought of by several 
eminent practitioners. Of the real nature of the 
disease, or the precise cause of it, I could form no 
rational conjecture ; but, among the numerous phe- 
nomena present in her case, there was evident de- 
rangement of the stomach and bowels. To this point 
several of her medical attendants had directed their 
attention, and all the usual means had been employ- 
ed to correct this part of the complaint, but without 
success. Purgatives almost invariably increased her 
sufferings, and she so dreaded the operation of a 
cathartic, that she sometimes allowed her bowels to 
be long constipated rather than take aperient medi- 
cine. Not knowing what else to do, I gave her the 
nitrate of silver, at first in doses of half a grain 
twice a day, gradually increasing it to four grains 
per diem, and that continued for the space of three 
months. At the same time I gave her a very small 
proportion of sulphate of quinine, not more than 
one, two, or three grains daily, and a common ape- 
rient pill to take when the bowels were confined. 
Long before the expiration of three months, she 
lost almost the whole of her complaints, and I saw 
her a few weeks ago, in the enjoyment of good 
health. Whether the disease may return, I cannot 
tell ; but the change that was wrought by this plan, 
was equally surprising to the patient and to my-' 
self. I am now exhibiting the same medicine, in 
combination with small doses of quinine, to some 
patients affected with obstinate dyspepsia, in that 
form which is more marked by the morbid sympa- 
thies of distant parts than by apparent disorder in 
the stomach and bowels themselves, and I have 
reason to believe, that the effects will be most bene- 
ficial. In one case, indeed, that of an elderly cler- 
gyman in Sussex, who has, for some years, laboured 
under a number of anomalous symptoms of a very 



THE STOMACH AND BOWELS. 125 

distressing nature, especially affecting the head, the 
organs of sense, and the powers of the mind, but in 
whom the stomach and bowels exhibited marks of 
morbid sensibility, the nitrate of silver and sul- 
phate of quinine have been productive of the great- 
est relief, and I may say that he is on the point of 
being completely cured. 

I know too well the fallacies of medicine to hold 
this remedy up as a specific for removing morbid 
irritability of the primai viae ; but I think I may 
safely recommend it to the notice of my professional 
brethren, as an auxiliary in such cases, which it 
may be worth their while to try. It may be exhi- 
bited in the form of a pill at night, combined with 
any bitter or aperient extract. It will not inter- 
fere with the operation of almost any other medi- 
cine with which it is administered. Thus, half a 
grain of nitrate of silver, and two, three, or four, of 
extract of rhubarb, or, if the bowels require no as- 
sistance, extract of camomile or gentian, may be 
given every night at bed-time, and the dose gradu- 
ally increased to two or three grains daily. No 
inconvenience can possibly result from the adminis- 
tration of the medicine, if not continued beyond 
three months at a time. But I must remark on this, 
as on almost every other medicine, that unless the 
strictest attention be paid to diet, all medicines will 
fail. I particularly wish to be understood as recom- 
mending the nitrate of silver only as an auxiliary 
in a complaint which often baffles the practitioner, 
and where all auxiliaries are occasionally needful. 
The quinine may generally be given at the same 
time, not in pills, but in solution. 

In respect to bitters, as a class of remedies calcu- 
lated to lessen morbid sensibility, and improve the 
function of digestion, there can be no doubt as to 
their utility, when given at the proper period. Of 
late years, I have found in the sulphate of quinine, 
M 



129 ON MORBID SENSIBILITY OF 

all the good properties of the other bitters, devoid 
of their bulk and other nauseating qualities. It is, 
in fact, the only bitter which we need in general 
and must ultimately supersede all others. In smali 
doses, as half a grain, thrice a day, dissolved in a 
tea-spoonful of any bitter tincture, as the compounc 
tincture of gentian, and diluted with a little toast 
and water, or any other fluid, it has an excellent ef- 
fect on the stomach, soothing its nerves, cleaning 
the tongue, improving the appetite, strengthening 
the digestion, and imparting tone and tranquillity 
to mind and body. If given in larger doses, espe- 
cially at the beginning, it stimulates too powerfully, 
and may do harm. It should, therefore, not be ex- 
hibited, till irritation is lessened by the subduction 
of improper food and the administration of proper 
medicines, and then it should be commenced in 
small doses, very gradually increased, and its ef- 
fects on the feelings watched as in respect to food, 
Managed in this way, it acts with surprising effica- 
cy, and it is not unusual for it to produce such a 
change in the appearance of invalids in a month or 
two, that the same person is hardly known. It 
should not be given in pills, as it is apt to pass un- 
digested in such forms, and thus disappoint the 
practitioner. Its effects are wanted on the sto- 
mach rather than on the bowels, and when medi 
cines are designed to operate on the former organ 
they should always be given in a liquid, or in i 
very soluble form, which is not the case with pills 
unless made soft and used the day they are com- 
pounded.* 

* The disease termed chorea is generally admitted as dependen' 
on irritation of the prims vise, and hence the practice of Dr. 
Hamilton, which consisted almost entirely in purgation. But ex- 
perience has now shewn that this plan will not always, perhaps 
not generally succeed. By it, we clear away irritating matters,»it | 
is true ; but the morbid sensibility remains, and our work is only 
half done. Hence the superior success which has attended the 



THE STOMACH AND BOWELS. 130 

It is useless, as indeed it would be endless, to 
enter into an examination of the farrago of bitters, 
tonics, stomachics, and other remedies which have 
been recommended in the various forms and shades 
of indigestion and hypochondriasis. All the indi- 
cations which they are capable of fulfilling may be 
fulfilled by the few which I have pointed out, and 
why need we have recourse to subordinate agents, 
when the principals are at command ? 

But as I have taken great pains to explain the 
nature of this class of diseases and the objects which 
it is desirable to obtain, so it would be waste of 
time to dwell on the minor means of effecting these 
objects. They will suggest themselves to every 
medical practitioner, and none but medical practi- 
tioners should attempt the treatment of a class of 
maladies which requires the utmost skill to man- 
age. The dietetic regimen, indeed, may be put in 
force by any invalid, under the guidance of the 
rules I have laid down ; but let him beware how he 
meddles with the medical management of his com- 
plaint. If the indications to be fulfilled demand 
the minutest attention of the medical practitioner, 
how is it possible that the patient can judge of 
such difficult matters? 

The subject of exercise, though, strictly speaking, 
a physical remedy, and one of great importance in 
this class of disorders, especially in hypochondria- 
sis, will be glanced at presently under the head of 
moral remedies, with which it usually is associated. 

As to the host of symptomatic affections of dif- 
ferent parts of the body, originating in disordered 
conditions of the digestive organs, it is unnecessary 
to dwell on their treatment in this place. While 
they are merely sympathetic, (as they generally 

practice of following up the purgative plan by bitters and tonics. 
The former removes the irritants — the latter the susceptibility to 
the action of future irritants. 






131 ON MORBID SENSIBILITY" OP 



are,)" they require no other treatment than that 
which is necessary for the removal of the disorder 



on which they depend, and when they become or- 
ganic affections, and independent of the cause which 
first produced them, their treatment will not differ 
from that employed for original or idiopathic affec- 
tions of the same organs or parts. The symptoma- 
tic disease of the lungs has been sufficiently consi- 
dered in a former part of this Essay, and I shall only 
glance at some of the others. 

The palpitation, or irregular action of the heart, 
which so often attends disorder of the stomach, is 
the most alarming of all. Headach, giddiness, 
noise in the ears, pains over the eye-brows, confu- 
sion of thought, loss of memory and other symp- 
toms about the head, are known, even to a pro- 
verb, to depend so often on the state of the stomach, 
that their existence seldom occasions much anxiety 
in either patient or practitioner ; but when the pulse 
begins to intermit, and the heart to beat irregularly 
against the ribs, great danger is usually apprehend- 
ed by the invalid, and the medical practitioner, 
who is not well versed in this class of complaints, 
is not un frequently thrown off his guard, and forms 
a more melancholy prognosis than the case gene- 
rally deserves. In these symptomatic affections of 
the organ of the circulation, however irregular may 
be the action of the heart and the pulse, they are 
not accompanied by the other usual attendants on- 
organic disease. The breathing is but little dis- 
turbed, the countenance has not the look of dis- 
tress, the lips are not blue, there is no oedema of 
the limbs, and the irregular action subsides when 
the stomach and bowels are empty, and the mind 
of the patient tranquil. But, as the surest proof of 
sympathetic disorder, the examination of the heart 
by auscultation, in the intervals, will shew that 
there is no enlargement, valvular imperfection, or 



THE STOMACH AND BOWELS. 132 

other change of structure present. In such instan- 
ces, by confining the patient to a rigid diet for a day 
or two, and gently clearing the bowels, it may be 
proved to his own satisfaction that there is no dis- 
ease, nor even permanent disorder of function in 
the case. It is quite useless to prescribe any medi- 
cine for such sympathetic affection — " sublata 
causa, tollitur effectus." 

The sympathetic disorders about the kidneys, 
bladder, urethra, and rectum, are far more puzzling, 
and difficult to ascertain. Strictures of the rectum 
and urethra will be so completely imitated in dis- 
ordered states of the digestive organs, that both the 
urine and faeces will be expelled with considerable 
pain and difficulty, the former in a small twisted 
stream, the latter in flattened and spiral cylinders 
of very diminutive calibre, while both passages will 
resolutely resist the introduction of a bougie, there- 
by confirming the inexperienced practitioner in the 
belief of permanent organic stricture. It is very 
common, in these cases, for patients to complain, 
not only of irritation in making water, but of a 
sense of pain and smarting in the rectum for some 
minutes after each discharge of urine. The blad- 
der, too, will often be so irritable, that not more 
than half a pint of water can be retained. This last 
will generally deposit a sediment when cold, un- 
less there be much nervous irritability of the mind, 
when it will be as pale as distilled water. When 
these symptoms are present, the prognosis should 
be suspended till the disorder of the digestive or- 
gans is removed, or mitigated as there can be no 
hurry for the treatment of stricture, even if it be 
actually of an organic nature. In nine cases out of 
ten, these symptoms about the two passages will 
subside, pari passu, with the disorder that pro- 
duced them. In fact, where there is real perma- 
nent stricture of either of the canals, there is sel- 
M 2 






133 ON MORBID SENSIBILITY OF 



dom half so much inconvenience felt, as where the 
stricture is temporary and sympathetic. — Such ca- 
ses afford a fine harvest for the unprincipled char- 
latan, who has little difficulty in persuading the pa- 
tient that he labours under a disease requiring con- 
stant mechanical treatment. This very treatment 
not unfrequently produces the very disease which 
it is pretended to remove, by the officious inter- 
ference of bougies, without proper attention to the 
constitutional disorder on which it depends. In 
what way, besides through the inscrutable channel 
of morbid sympathy, these affections of the kidneys, 
bladder, rectum, and urethra, are produced it is dif- 
ficult to say, but it is not improbable that the acri- 
monious secretions themselves may contribute much 
to the setting up of these local irritations imitating 
organic diseases of the parts thus irritated. 



MORAL REMEDIES. 



The moral causes of indigestion and hypochon- 
driasis are very numerous, but not so the remedies. 
The physician sees and deplores the operation of 
these causes, but he can do little more than combat 
their physical effects, and thus prevent, as much as 
possible, their re-action on the mind, through, the 
medium of which they were first directed to cer- 
tain organs of the body. What power can he exert 
over the thousand sources of mental anguish re- 
sulting from disappointed ambition, blighted hopes, 
ruined prospects, reverses of fortune, mercantile 
losses, domestic affliction, crosses in love, and all 
the varied ills to which the spirit as well as the 
flesh is heir ?— None have such opportunities of ob- 
serving the devastations committed on the body by 



THE STOMACH AND BOWELS. 134 

the workings of the mind, as the medical philoso- 
pher. None can see the intimate connexion be- 
tween mind and matter, so clearly as he can. If 
metaphysicians had been physicians, they would 
not have issued into the world so many absurd specu- 
lations on the nature of the mental faculties, which 
they descant upon as independent of the corporeal 
organs through which they are manifested. Be 
this as it may, we find that men, labouring under 
moral afflictions, derive but little benefit from the 
moral lectures of the philosopher, or even the di- 
vine, on the virtues of patience, resignation, and 
calm submission to the dispensations of Providence 
and vicissitudes of fortune ! — Time, it is true, ef- 
fects a mitigation of our sorrows, and the mind, 
like the body, becomes accustomed to painful im- 
pressions, and ceases, at length, to feel them with 
much poignancy. But, as certain conditions of our 
corporeal functions greatly aggravate the mental af- 
fliction ; so other, and opposite conditions of the 
same functions do more to fortify the mind, than all 
the lectures of the moralist, the philosopher, or the 
divine. At all events, the physician can only 
work through physical agency, leaving to others, 
if such can be found, the pleasing task of curing the 
wounds of our spiritural nature by the balm of 
friendship and the consolations of religion. 



COMBINATION OF MORAL AND PHYSL 

CAL REMEDIES, AND ESPECIALLY 

EXERCISE. 



It is well known that one impression, whether 
mental or corporeal, will often supersede, or at 
least weaken another. This principle is sometimes 






135 ON MORBID SENSIBILITY OP 

available in the cure of dyspepsia and hypochon- 
driasis, especially when resulting from moral cau- 
ses. If the patient's circumstances will permit him 
to engage in any pursuit that can occupy his at- 
tention and exercise his body, it will prove one of 
the most powerful means of counteracting the ori- 
ginal cause, as well as of removing its effects. Un- 
fortunately there are but few, comparatively speak- 
ing, whose circumstances will permit of the em- 
barkation in any new pursuit. Yet it is in the 
power of a great many to engage in a systematic 
exercise of the body, in some mode or other, if they 
will only summon resolution to make the experi- 
ment. The languor and listlessness attendant on 
the disorder are great obstacles to this plan, but 
they should be urged to it by all the eloquence of 
their medical attendants. Some caution, however, 
is necessary here. The debility and exhaustion 
which supervene on the most trifling exertion deter 
most people from persevering, and, therefore, the 
corporeal exercise must be commenced on the low- 
est possible scale, and very gradually increased. 
Thus, a person whose sedentary occupations con- 
fine him to the house, might begin by going once 
to the top of the stairs the first day, twice the se- 
cond day, and so on, till he could run up and down 
the same path some hundreds of times each day. 
It is wonderful what may be accomplished in this 
way by perseverance. I have known people, who 
could not go up a flight of steps without palpitation 
and breathlessness, acquire, in one month, the pow- 
er of running up to the top of the house one hun- 
dred times in the space of an hour, with scarcely 
any acceleration of the pulse or respiration. If the 
exercise can be taken in the open air, it will be 
still better, and the quantum gradually increased, 
by twenty or thirty steps daily. This task, which 
should be represented as an infallible remedy in 



THE STOMACH AND BOWELS. 136 

the end, must be performed at first when the sto 
mach is nearly empty ; and when an increase of 
muscular power is acquired, it may be performed 
at any time> even immediately after dinner. Those 
who can engage in any of the lighter gymnastic 
exercises, now becoming so common, should be 
urged to it by every kind of persuasion, especially 
in the cool seasons of the year. These are means 
within the reach of almost all, and the advantages 
to be derived from such a system are incalculable* 
By this systematic exertion of the body, with very 
spare diet, most cases of dyspepsia might be com- 
pletely cured among the middling and lower clas- 
ses of society.* 

But there is a large class whose morale has been 
too far spoiled ; whose education has been too re- 
fined ; and whose senses have been too much pam- 
pered, to benefit by such simple means. There 
must be some incentive to corporeal exertion 
stronger than the foregoing plan presents; and moral 
excitement must be combined with physical agency, 
if we hope to carry our projects into beneficial ope- 
ration. That the long catalogue of dyspeptic and 
hypochondriacal complaints is much more frequent- 
ly the inheritance of the affluent than, of the indi 
gent, there can he no doubt ; and yet the former 
class have a remedy in their power which is infi- 

* It is very doubtful which is the more salutary kind of exercise 
— pedestrian or equestrian. I am inclined to agree with Dr. Parry,, 
in giving the preference to the former, as the more natural of the 
two. But as weakly persons will be induced to ride who would 
not walk, the horse-exercise is one of our most valuable remedies, 
in dyspepsia, as well as m many other diseases. If the individual* 
however, could be enticed to commence, and gradually increase* 
the active or pedestrian species, of exercise, it would certainly be 
far more efficacious in the removal of indigestion and hypochon- 
driacism than the passive, or comparatively passive exercise of ri- 
ding. There are some complaints, however, as of the heart and 
lungs, where passive is safer than active exercise, on account of the- 
temporary excitement of the circulation and respiration occasioned" 
by the latter. 






137 ON MORBID SENSIBILITY OP 

nitely more efficacious than all the other moral and 
physical means put together, but which they rarely 
take advantage of — or, when they do embrace it, 
they seldom go the proper way to work. This is 

TRAVELLING. 

Since the Continent has been open to the En- 
glish, there has been no lack of this species of exer- 
cise ; but there are different kinds of travelling now, 
as there were different kinds of travellers in the 
days of Sterne. It is one thing to travel for health, 
and quite another thing to travel for the sake of 
studying architectural ruins, viewing pictures, ran- 
sacking libraries, or collecting antiquities. It is 
entirely with the first kind of travelling that I have 
to do — namely, that mode which conduces most to 
the restoration of health, leaving every other con- 
sideration entirely out of the question, with the 
exception of amusement, which I consider as es- 
sentially connected with the subject of health. In 
the course of a wandering life, I have had many op- 
portunities of studying the effects of travelling on 
different diseases ; but more recently I made one of 
a party whose sole object was the trial of a plan 
which I had devised for recruiting the health of 
three invalids, including myself. It may not be 
wholly uninteresting to the medical practitioner or 
the invalid, if I preface the remarks which I have 
to offer on the effects of travelling, by a concise 
sketch of the plan which was pursued in the present 
instance. 

Six individuals, three in health (domestics) and 
three valetudinarians, (one a lady,) travelled, in the 
months of August, September, and October, 1823, 
about 2500 miles, through France, Switzerland, 
Germany, and Belgium, for the sole purpose of 
health, and such amusement as was considered 
most compatible with the attainment of that object. 

The experiment was tried, whether a constant 



THE STOMACH AND BOWELS. 138 

change of scene and air, combined with almost un- 
interrupted exercise, active and passive, during the 
day, principally in the open air, might not insure 
a greater stock of health than slow journies and 
long sojourns on the road. The result will be seen 
presently. But, in order to give the reader some 
idea of what may be done in a three months' tour 
of this kind, I shall enumerate the daily journies, 
omitting the excursions from those places at which 
we halted for the night, or for a few days. Our lon- 
gest sojourn was that of a week, and that only thrice; 
at Paris, Geneva, and Brussels. In a majority of 
places we only stopped a night and part of a day ; 
or one or two days, according to local interest. But 
I may remark that, as far as I was concerned, more 
exe: cise was taken during the days of sojourn at 
each place, than during the days occupied in tra- 
velling from one point to another. The conse- 
quence was, that a quarter of a year was spent in 
one uninterrupted system of exercise, change of 
air, and change of scene, together with the mental 
excitement and amusement produced by the per- 
petual presentation of new objects; many of them 
the most interesting on the face of this globe. The 
following were the regular journeys, and the points 
of nightly repose : — 1, Sittingbourn — 2, Dover — 3, 
Calais — 4, Boulogne — 5, Abbeville — 6, Rouen — 7, 
Along the banks of the Seine to Mantes — 8, Paris, 
with various excursions and perambulations— 9, 
Fontainbleau — 10, Auxerre — 1 1 , Vitteaux — 1 2, Di- 
jon, with excursions — 13, Champagnole, in the Jura 
Mountains — 14, Geneva, with various excursions — 
15, Salenche — 16, Chamouni, with various excur- 
sions to the Mere de Glace, Jardin, Buet, &c. — 17, 
Across the Col de Balme to Martigny, with excur- 
sions up the Vallais — 18, By the Valley of Entre- 
ment, &c. to the Great St Bernard, with excur- 
sions — 19, Back to Martigny — 20, Vivian, on the 



139 ON MORBID SENSIBILITY OF 

Lake of Geneva, with excursions — 21, Geneva — 
22, Lausanne, with excursions — 23, La Sarna — 24, 
Neuf-chatel — 25, Berne, with excursions and per- 
ambulations — 26, Thoun — 27, Valley of Lauter- 
brunen, with various circuits — 28, Grindewalde, 
with excursions to the Glaeiers, &c. — 29, Over the 
Grand Scheidec to Meyrengen, with excursions to 
waterfalls j &c. — 30, By Brienz, Lake of Brienz, 
Interlaken, and Lake of Thoun, with various ex- 
cursions, to the Giesbach and other waterfalls, back 
to Thoun — 31, Berne — 32, Zoffengen — 33, Lu- 
cerne, with various excursions — 34, Zoug and Zu- 
rich — 33, Chaufhausen and Falls of the Rhine — 
36, Neustad, in the Black Forest— 37, By the Val - 
lee d'Enfer to Offenburgh — 38, Carlshrue, with ex- 
cursions — 39, Heidelbergh — 40, Darmstadt — 41, 
Frankfort on the Maine, with excursions — 42, 
Mayence, with excursions — 43, Coblentz, Bingen, 
Bonn, &c. — 44, Cologne — 45, Aix La Chapelle, 
w 7 ith excursions — 46, Liege — 47, Brussels, with a 
week's excursions — 48, Ghent and Courtray — 49, 
Dunkirk — 50, Calais — 51, Dover — 52, London. 

Thus, there were 52 regular journeys during the 
tour, and 32 days spent in excursions and perambu- 
lations. And as there never was so much exercise 
or fatigue during the journeys as during the days of 
sojourn and excursions, it follows that the whole of 
this tour might be made with great ease, and the 
utmost advantage to health, in two months. As 
far as natural scenery is concerned, it would, per- 
haps, be difficult to select a track, which could offer 
such a succession of the most beautiful and sublime 
views, and such a variety of interesting objects, as 
the line which the above route presents. It would 
be better, however, to dedicate three months to the 
tour, if the time and other circumstances permitted, 
than to make it in two months ; though, if only two 
months could be spared, I would recommend the 



EFFECTS OF TRAVELLING. 140 

same line of travel, where health was the object. 
Perhaps, it would be better, however, to reverse 
the order of the route, and to commence with the 
Rhine, by which plan the majesty of the scenery 
would be gradually and progressively increasing, 
till the traveller reached the summit of the Great 
St. Bernard. 

The foregoing circuit was made, as far as the 
writer is concerned, entirely in the open air, that 
is to say, in an open carriage ; in char-a-bancs; on 
mules; and on foot. The exercise was always a 
combination, or quick succession of the active and 
passive kinds, as advantage was always taken of 
hills and mountains, on the regular journeys, to get 
down and walk ; while a great part of each excur- 
sion was pedestrian, with the char-a-banc or mule 
at hand, when fatigue was experienced.* This 
plan possesses many advantages for the invalid, over 
the purely active or purely passive modes of tra- 
velling. The constant alternation of the two, se- 
cures the benefits of both, without the inconveni- 
ence of either. As the season for travelling in 
Switzerland, is the hottest of the year, and as, in 
the valleys, the temperature is excessive, so, great 
danger would be incurred by the invalid's attempt- 
ing pedestrian exercise in the middle of the day. 
But, by travelling passively in the hot valleys, and 
walking whenever the temperature is moderate or 
the ground elevated, he derives all the advantage 
which exercise of both kinds can possibly confer, 
without any risk to his health. 

The journeys on this tour varied from 20 to 50 
or 60 miles in the day, and was always concluded 
by sunset — often much before that period. The 

* The writer of this has little hesitation in averring, that he 
walked full half of the whole distance which was traversed in this 
tour, that is, that in a quarter of a year, he walked twelve or thir- 
teen hundred miles. 

N 



i 






141 ON MORBID SENSIBILITY OF THE STOMACH, &C. 

usual routine of meals was, some coffee at sunrise, 
and then exercise, either in perambulations, excur- 
sions, or on the first stage of the day's journey. At 
noon, a dejenne a la fourchette, and then imme- 
diately to exercise or to travel ; concluding the 
journey and the exercise of the day by dinner at 
the 8 o'clock table d'hote, where the company, of 
all nations, varying from 10 to 50 or 60 were sure 
to assemble, with appetites of tygers rather than of 
men. By ten, or half-past ten, all were in bed, 
and there was seldom a waking interval from that 
time till six in the morning, the punctual hour of 
rising. In this circuit we experienced great and 
sometimes very abrupt vicissitudes of temperature, 
as well as other atmospheric changes, but, as will 
be presently seen, without any bad consequences. 
Before I give any exposition of the moral and physi- 
cal effects of this kind of exercise, I may be per- 
mitted to premise, that I made it one of my prin- 
cipal studies, during the whole course of the tour, 
not only to investigate its physiological effects on 
my own person and those of the party, six in num- 
ber; but to make constant enquiries among the nu- 
merous and often intelligent travellers with whom 
I journeyed or sojourned on the road. Many of 
these were invalids — many affected with actual dis- 
eases — a considerable proportion had had dyspep- 
tic complaints previously, — and all were capable of 
describing the influence of travelling exercise on 
their mental and corporeal functions. What I am 
going to say on this subject, therefore, is the re- 
sult of direct experience and observation, unbiassed 
by any preconceived opinions derived from books 
or men. I am not without hope that my observa- 
tions will be of some service to the physician as 
well as to the invalid, by putting them in posses- 
sion of facts, which cannot be ascertained under any 



EFFECTS OF TRAVELLING. 142 

other circumstances than those under which they 
were investigated in the present instance. 

1. Moral Effects. If abstraction from the cares 
and anxieties of life, from the perplexities of busi- 
ness, and, in short, from the operation of those con- 
flicting passions which harrass the mind and wear 
the body, be possible under any circumstances, it 
is likely to be on such a journey as this, for which 
previous arrangements are made, and where a con- 
stant succession of new and interesting objects is 
presented to the eye and understanding, which pow- 
erfully arrests the attention and absorbs other feel- 
ings, leaving little time for reflexions on the past, 
or gloomy anticipations of the future. To this 
may be added, the hope of returning health, in- 
creased, as it generally will be, by the daily acqui- 
sition of that invaluable blessing, as we proceed. 

One of the first perceptible consequences of this 
state of things, is a greater degree of serenity or 
evenness of temper, than was previously possessed. 
There is something in the daily intercourse with 
strangers, on the road, and at the tables d'hote, 
which checks irritability of temper. We are not 
long enough in each other's society to get into ar- 
gumentation, or those collisions of sentiment which 
a more familiar acquaintance produces, and too of- 
ten raises into altercations and even irascibility, 
where the mind and body are previously irritable. 
These short periods of intercourse are the honey- 
moons of society, where only good humour and 
politeness prevail. We change our company be- 
fore we are intimate enough to contradict each 
other, and thus excite warm blood. Besides, the 
conversation generally turns on scenes and subjects 
with which we are pleased and interested on the 
road, while political and religious discussions are 
studiously avoided by all travellers, as if by a tacit 



143 ON MORBID SENSIBILITY OF THE STOMACH, &C. 

but universal compact. One of the best remedies, 
then, for irritability of temper, is a tour of this 
kind. A few hundred pounds would be well ex- 
pended by many of our rich countrymen, in ap- 
plying this pleasant remedy to the mind, when 
soured and unpoised by the struggle after wealth, 
rank, or power ! 

I have already pourtrayed the influence of bad 
health, and especially of disordered states of the 
digestive organs, in producing depressions of spir- 
its, or mental despondency, far worse to bear than 
corporeal pain. For the "removal of this kind of 
melancholy, there is no other moral or physical 
remedy of half so much efficacy as a tour conducted 
on the plan which I have pointed out. It strikes 
at once at the root of the evil, (as I shall presently 
shew, when speaking of the physical effects of 
travelling,) by removing the causes on which this 
sombre state of mind depends. It is true that, in 
some cases of confirmed hypochondriacism, no 
earthly amusement, no change of scene, no mental 
impressions or excitement, no exercise of the body, 
can cheer the gloom that spreads itself oyer every 
object presented to their eye or their imagination I 
With them, change of place is only variety of woe — 
coslum non animum mutant. Yet, from two or 
three instances which have come within my know- 
ledge, of the most inveterate and incurable hypoch- 
ondriacism being mitigated by travelling, (though 
the mode of conducting the journey was far from 
good,) I have little doubt but that many cases of 
this kind, which ultimately end in insanity, or at 
least in monomania, might be greatly ameliorated, 
if not completely cured, by a system of exercise 
constructed on the foregoing plan, and urged into 
operation, by powerful persuasion, or even by 
force, if necessary. The change for the better, in 
such cases, is not perceptible at the beginning of 



EFFECTS OF TRAVELLING. 144 

the tour ; but when the functions of the body have 
once begun to feel the salutary influence of the 
journey, the mind soon participates, and the gloom 
is gradually, though slowly dispelled. Where the 
mental despondency is clearly dependent on disor- 
der of the digestive organs, and has not yet indu- 
ced an)' permanent disease of the brain, an almost 
certain cure will be found in a journey of this kind, 
for both classes of complaints. It is hardly neces- 
sary to observe that beneficial effects, though not, 
perhaps, to the same extent, will be experienced in 
other sombre and triste conditions of the soul, re- 
sulting from moral causes, as sorrow, grief, disap- 
pointments, crosses in love, &c. by a tour conduct- 
ed in such a manner as strongly to exercise the 
body, and cheerfully to excite the mind. 

I have already shewn the powerful influence of 
moral causes in deranging the functions of the body 
through the medium of the intellectual functions. 
The same functions may be made the medium of a 
salutary influence. In most nervous and hypo- 
chondriacal complaints, the attention of the patient 
is kept so steadily fixed on his own morbid feel- 
ings as to require strong and unusual impressions 
to divert it from that point. The monotony of do- 
mestic scenes and circumstances is quite inadequate 
to this object, and arguments not only fail, but ab- 
solutely increase the malady by exciting irritation 
in the mind of the sufferer, who thinks his coun- 
sellors are either unfeeling or incredulous towards 
his complaints. In such cases, the majestic scene- 
ry of* Switzerland, or the picturesque and beautiful 
views in Italy or the Rhingau, combined with the 
novelty, variety, and succession of manners and 
customs of the countries through which he passes, 
abstract the attention of the hypochondriacal trav- 
eller (if any thing can) from the hourly habit of 

N 2 



145 ON MORBID SENSIBILITY OF THE STOMACH, &C* 

exaggerating his own real or imaginary sensations, 
and thus help to break the chain of morbid associa- 
tion by which he is bound to the never-ending de- 
tail of his own sufferings. This is a paramount ob- 
ject in the treatment of these melancholy com- 
plaints; and I am convinced that a journey of this 
kind, in which mental excitement and bodily ex- 
ercise were skilfully combined, would not only ren- 
der many a miserable life comparatively happy, 
but prevent many a hypochondriac from lifting his 
hand against his own existence. It would unques- 
tionably preserve many an individual from mental 
derangement. 

This principle was well understood long before 
medicine was established as a science. At the ex- 
tremities of Egypt were two temples dedicated to 
Saturn, and to these the melancholies or hypochon- 
driacs of ancient days were sent in great numbers. 
There the priests worked on the body as well as 
the mind by the pretended influence of supernatural, 
and the real influence of medicinal agents. The 
consequence was, that miracles, or at least miracu- 
lous cures were daily performed. The Romans 
sent their invalids to Egypt for change of scene, 
and Hippocrates has distinctly recommended those 
afflicted with chronic diseases, to change the air 
and soil — " In morbis longis solum mutare." It 
would be going out of my province to speak of the 
benefits of travelling in any other moral point of 
view than that which is connected with the restora- 
tion of health. I shall, therefore, proceed to a 
consideration of the effects of this combination of 
mental and corporeal exercise on our bodily func- 
tions. 

—II. Physical Effects, The first beneficial influ- 
ence of travelling is perceptible in the state of our 
corporeal feelings. If they were previously in a 



EFFECTS OF TRAVELLING. 146 

state of morbid acuteness, as they generally are in 
ill health, they are rendered less sensible. The eye, 
which was before annoyed by a strong light, soon 
becomes capable of bearing it without inconveni- 
ence; and so of hearing and the other senses. In 
short, morbid sensibility of the nervous system gen- 
erally is obtunded, or reduced. This is brought 
about by more regular and free exposure to all at- 
mospheric impressions and changes than before, and 
that under a condition of body, from exercise, which 
renders these impressions innocuous. Of this we 
see the most striking examples in those who travel 
among the Alps. Delicate females and sensitive 
invalids, who, at home, were highly susceptible of 
every change of temperature and other states of the 
atmosphere, will undergo extreme vicissitudes 
among the mountains, without the smallest inconve- 
nience. I will offer an example or two in illustra- 
tion. In the month of August, 1823, the heat was 
excessive at Geneva and all the way among the de- 
files of the mountains till we got toChamouni, where 
we were, all at once, among the ice and snow, with 
a fall of 40 or more degrees of the thermometer, 
experienced in the course of a few hours, from mid- 
day at Salenche, to the evening at the foot of the 
Glaciers in Chamouni. There were upwards of 50 
travellers here, many of whom were females and 
invalids; yet none suffered any inconvenience from 
this rapid transition. This was still more remark- 
able in the journey from Martigny to the Great St. 
Bernard. On our way up, through the deep vallies, 
we had the thermometer at 92° for three hours. I 
never felt it hotter in the East Indies. At nine 
o'clock that night, while wandering about the Hos- 
pice of the St. Bernard, the thermometer fell to six 
degrees below the freezing point, and we were all 
nearly frozen in the cheerless apartments of the mon- 
astery. There were upwards of 40 travellers there — 



147 ON MORBID SENSIBILITY OP THE STOMACH, &C. 

some of them in very delicate health, and yet not a 
single cold was caught, nor any diminution of the 
usual symptom of a good appetite for breakfast next 
morning. This was like a change from Calcutta to 
Melville Island in one short day! So much for the 
ability to bear heat and cold by journeying among 
the Alps. Let us see how hygrometrical and ba- 
rometrical changes are borne. A very large con- 
course of travellers started at day-break from the 
village of Chamouni to ascend the Montanvert and 
Mere de Glace. The morning was beautiful; but 
before we got two-thirds up the Montanvert, a tre- 
mendous storm of wind and rain came on us without 
a quarter of an hour's notice, and we were drenched 
to the skin in a very few minutes. Some of the 
party certainly turned tail, and one Hypochondriac 
nearly threw me over a precipice, while rushing 
past me in his precipitate retreat to the village. 
The majority, however, persevered, and reached 
the Chalet, dripping wet, with the thermometer 
below the freezing point. There was no possibili- 
ty of warming or drying ourselves here, and there- 
fore many of us proceeded on to the Mere de 
Glace, and then wandered on the ice till our clothes 
were dried by the natural heat of our bodies. The 
next morning's muster for the passage over the Col 
de Balme shewed no damage from the Montanvert 
expedition. Even the Hypochondriac above-men- 
tioned regained his courage over a bottle of Cham- 
pagne in the evening at the comfortable " Union," 
and mounted his mule next morning to cross the 
Col de Balme. This day's journey shewed, in a 
most striking manner, the acquisition of strength 
which travelling confers on the invalid. The as- 
cent to the summit of this mountain is extremely 
fatiguing, but the labour is compensated by one of 
the sublimest views from its highest ridge, which 
the eye of man ever beheld. The descent, on the 



EFFECTS OF TRAVELLING. 14S 

Martigny side, was the hardest day's labour I ever 
endured in my life, yet there were three or four in- 
valids with us, whose lives were scarcely worth 
a year's purchase when they left England, and who 
went through this laborious, and somewhat hazard- 
ous descent, sliding, tumbling, and rolling over 
rocks and through mud, without the slightest ulti- 
mate injury. When we got to the goat-herds' 
sheds in the valley below, the heat was tropical, 
and we all threw ourselves on the ground and slept 
soundly for two hours, rising refreshed to pursue 
our journey. Now these and many other facts 
which 1 could adduce, offer incontestible proof 
how much the morbid susceptibility to transitions 
from heat to cold — from drought to drenchings — is 
reduced by travelling. The vicissitudes and exer- 
tions which I have described would lay up half the 
effeminate invalids of London, and kill, or almost 
frighten to death, many of those who cannot expose 
themselves to a breath of cold or damp air, without 
coughs or rheumatisms, in this country. These 
facts may suggest some important indications to the 
physician who has charge of patients [labouring un- 
der, or threatened with, certain affections of the 
chest. I am strongly inclined to believe that 
many cases of incipient phthisis might be cured of 
the disposition to that terrible disease, by timely 
and cautious removal of morbid susceptibility to 
atmospheric impressions, by means of travelling in 
proper seasons, in proper countries, and in a proper 
manner. A young gentleman from Paris, was one 
of the party to the Montanvert, over the Col de 
Balme, and afterwards to the Great St. Bernard. 
He had strongly marked characters of incipient 
phthisis, and was travelling for his health. His 
breath was so short in ascending the mountains, 
and he coughed so violently, that I fully expected 
he would burst a blood-vessel in the lungs by his 



149 ON MORBID SENSIBILITY OP THE STOMACH, &C. 

exertions. I had some difficulty in persuading him 
to mount my mule, of which I made no use, in 
getting up the Col be Balme, and I had much con- 
versation with him during our peregrinations to- 
gether. He informed me that he had had haemop- 
tysis several times in France; but that he had got 
much better and stronger since he had travelled in 
Switzerland. He had entirely lost all feverishness 
lately, and only experienced shortness of breath 
and cough on going up steep ascents. He had 
never caught cold from the time he set out on his 
journey, and felt no alarm at exposure to atmos- 
pheric vicissitudes in his perambulations among the 
mountains. I fell in with him nearly a month 
after this, in a more northern direction, and he was 
greatly improved in appearance. Several other 
travellers, with whom I had conversation, informed 
me they had entirely lost habitual coughs and great 
susceptibility to cold, while travelling in Switzer- 
land. These things do not harmonize with the 
doctrines of the schools, but facts are facts, and I 
leave them to the consideration of my professional 
brethren. The next effect of travelling which I 
shall notice, is its influence on the organs of digest- 
ion. This is so decided and obvious, that I shall 
not dwell long on the subject. The appetite is not 
only increased ; but the powers of digestion and 
assimilation are greatly augmented. A man may 
eat and drink things, while travelling, which would 
make him quite ill previously. A strong proof of 
its effects on assimilation is afforded by the univer- 
sal remark that, although much more food is taken 
in while travelling, much less faecal remains are 
discharged, and costiveness is a very general symp- 
tom among those who make long and repeated jour- 
neys, especially in a carriage or on horseback. The 
motions which were previously of bad colour and 
consistence, soon become formed or even solid, and 



EFFECTS OF TRAVELLING. 150 

of a perfectly healthy appearance. The constipa- 
tion, which attends passive or mixed exercise, on 
these occasions, is hardly ever attended with any 
inconvenience; and travellers will go two or three 
days without a motion, and experience no uncom- 
furtable sensation, although the same degree of con- 
finement of the bowels, at other* times, would ren- 
der them ill, or at least very uncomfortable. 

These unequivocally good effects of travelling on 
the digestive organs, account satisfactorily for the 
various other beneficial influences on the constitu- 
tion at large. Hence dyspepsia, and the thousand 
wretched sensations and nervous affections thereon 
dependent, vanish before persevering exercise in 
travelling, and new life is imparted to the whole 
system, mental and corporeal. In short, I am quite 
positive that the most inveterate dyspepsia (where 
no organic disease has taken place) would be com- 
pletely removed, with all its multiform sympathe- 
tic torments, by a journey of two thousand miles 
through Switzerland and Germany, conducted on 
the principle of combining active with passive ex- 
ercise in the open air, in such proportions as would 
suit the individual constitution and the previous 
habits of life. This, it is true, is the rich man's 
remedy. But what is the expenditure of time and 
money, necessary for its accomplishment, compar- 
ed with the inestimable blessing of restored health ? 
How many thousand opulent invalids saunter away 
their time and their wealth, at watering places in 
this country, during the summer and autumn, with 
little or no improvement of constitution, when a 
three months' course of constant exercise in the 
open air, would cure them of ali their mala- 
dies ! The fact is, the power of this remedy is 
little known, and the manner in which it is applied 
by many invalids, is not calculated to shew its 
worth. 



151 ON MORBID SENSIBILITY OF THE STOMACH, &C 

The kind of exercise under consideration has a 
marked influence on the absorbent system. It ex- 
cites this class of vessels into great activity. The 
fluids, even from the bowels, are rapidly taken up 
into the circulation, and thrown off by the skin, 
which is one cause of the constipation to which 
travellers are subject. This increase of activity in 
the function of the skin, exerts a very salutary in- 
fluence on the functions of various internal organs, 
with which the surface is sympathetically associat- 
ed. The secretion of bile is thus greatly improved, 
and this is of no mean consequence in many com- 
plaints* To the tropical invalid, with torpid liver 
and torpid skin, this remedy presents the highest 
advantages ; and I hope the present remarks will 
induce him not to neglect such an agreeable and 
useful remedy. 

The effects of travelling, on the absorbents, point 
at once to the benefits which may be derived from 
it, in cases where there is a dropsical tendency. In 
one gentleman whom I knew on this tour, there 
had been an cedematous state of the lower extremi- 
ties for many years, but whose legs became as small 
as ever they had been, in the course of one month's 
travelling. This activity of the absorbents causes 
the fat and flabby parts of the body to be rapidly 
reduced, while the exercise and the improved di- 
gestion increase the force and firmness of the mus- 
cular system. Hence corpulent people become 
thinner on the journey, but their muscles are in- 
creased in size; and what they lose in weight they* 
gain in strength. This salutary change of propor- 
tion between the muscular and the adipose systems 
of the body gives greater freedom to the functions 
of many important organs, especially to the heart 
and the lungs. Hence people who are easily put 
out of breath by exercise, or by going up an ascent, 



EFFECTS OF TRAVELLING. 152 

soon acquire power to do both, without inconve- 
nience. 

The increased activity of the absorbents, during 
the combination of active and passive exercise in 
travelling, offers a powerful agency for the remo- 
val of morbid growths in the body, such as tu- 
mours, scrofulous swellings, &c. and this is one 
reason why I think great advantage might be de- 
rived from travelling, in cases where there is a ten- 
dency to consumption — a disposition so much con- 
nected with scrofulous affection both internally and 
externally. 

The effects of travelling on the circulation are 
peculiar. Active exercise unquestionably quickens 
the pulse; while passive exercise in a carriage 
renders it slower. In those diseases of the heart, 
therefore, where there is enlargement of the organ, 
with increase of force in the circulation, I think 
there can be little doubt that travelling, with com- 
bined active and passive exercise, would be dan- 
gerous, and would be likely to augment the disease. 
In such cases, the exercise should be completely 
passive, and then the effects would be beneficial. 
But there are many eases where there is a morbid 
irritability of the heart, from sympathy with other 
organs, as the stomach, liver, &c. In these, travel- 
ling offers a powerfully salutary remedy, not only 
by lessening the irritability of the heart, but by im- 
proving the functions of those organs with which 
the heart sympathises. The travelling exercise, 
in these instances, should be at first entirely pas- 
sive, and, as the irritability of the organ decreases, 
active exercise might be gradually ventured on, 
and progressively augmented. The exercise of 
travelling, whether active, passive, or both com- 
bined, has a very marked influence in producing 
an equal distribution of the blood to all parts of the 
body. This important effect must render it a pow- 
M 



153 ON MORBID SENSIBILITY OP THE STOMACH, &C. 

erful agent in correcting undue determinations of 
blood to any particular organ or part — a phenome- 
non, which plays a conspicuous part in many of the 
most dangerous diseases to which the human fabric 
is liable. Hence, the utility of travelling, in many 
affections of the head and other parts to which an 
unequal distribution of blood may be habitually di- 
rected. 

There is but one other effect of travelling to 
which I shall allude, before I close this Essay, but 
I think it is a very important one, if not the most 
important of all. It is the influence which constant 
change of air exerts on the blood itself. Every 
one knows the benefits which are derived from 
change of air, in many diseases, when that change 
is only from one part to another, a few miles sepa- 
rated. Nay, it is proved, beyond all possibility of 
doubt, that the change from what is considered a 
good, to what is thought a bad air, is often attended 
with marked good effects. Hence it is very rea- 
sonable to conclude, that the mere change of one 
kind of air for another has an exhilarating or saluta- 
ry effect on the animal economy. It is true, that 
we have no instruments to ascertain in what con- 
sists this difference of one air from another, since 
the composition of the atmosphere appears to be 
nearly the same on all points of earth and sea. 
But we know from observation that there are great 
differences in air, as far as its effects on the human 
body are concerned. Hence, it would appear that 
the human body, confined to one particular air be 
it ever so pure, languishes at length, and is better- 
ed by a change. This idea is supported by analogy. 
The stomach, if confined to one species of food, 
however wholesome, will, in time, languish, and 
fail to derive that nutriment from it, which it 
would do, if the species of food were occasionally 
changed. The ruddy complexion then of travel- 



EFFECTS OF TBAVELLING. 154 

lers, and of those who are constantly moving from 
place to place, as stage-coachmen, does not, I think, 
solely depend on the mere action of the open air 
on the face ; but also on the influence which change 
of air exerts on the blood itself in the lungs. I con- 
ceive, then, that what Boerhaave says of exercise, 
may be safely applied to change of air. " Eo ma- 
gis et densam, etpurpuream sanguinem esse, quo 
validius homo se exercuerit motu musculorum." It 
is to this constant change of air, as well as to the 
constant exercise of the muscles, that I attribute the 
superiority of the plan of travelling which I have pro- 
posed, over that which is usually adopted — where 
health is the entire object. On this account, I 
would recommend some of my fair country-wo- 
men, who have leisure as well as means, to improve 
the languid states of their circulation, and the deli- 
cacy of their complexions, by a system of exercise 
in the open air, which will give colour to their 
cheeks, firmness to their muscles, tone to their 
nerves, and energy to their minds. 



FINIS. 




% 












°* 

- 






./ % 






v^ 

















v 0c> 









vV V 






c*% y 




A 









c*-_ 



$**%., 






. . . <r 








LIBRARY OF CONGRESS 



021 062 304 8 



■I 



MB 




